Provider Demographics
NPI:1881867620
Name:SMITH, SANDRA JO (ARDMS)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JO
Last Name:SMITH
Suffix:
Gender:F
Credentials:ARDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2868
Mailing Address - Country:US
Mailing Address - Phone:916-782-2229
Mailing Address - Fax:
Practice Address - Street 1:5 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 250
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2868
Practice Address - Country:US
Practice Address - Phone:916-782-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA488622471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography