Provider Demographics
NPI:1992369060
Name:HAIDER, SANDRA (DPM)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:HAIDER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:TALLAT
Other - Last Name:FARMAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29839 SANTA MARGARITA PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-3616
Mailing Address - Country:US
Mailing Address - Phone:949-209-9590
Mailing Address - Fax:
Practice Address - Street 1:29839 SANTA MARGARITA PKWY STE 100
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-3616
Practice Address - Country:US
Practice Address - Phone:949-209-9590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5851213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery