Provider Demographics
NPI:1013097534
Name:SENDER, MARK B (MD, IN)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:B
Last Name:SENDER
Suffix:
Gender:M
Credentials:MD, IN
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23823 VALENCIA BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-9513
Mailing Address - Country:US
Mailing Address - Phone:661-254-2777
Mailing Address - Fax:661-253-2837
Practice Address - Street 1:23823 VALENCIA BLVD STE 130
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91355-9513
Practice Address - Country:US
Practice Address - Phone:661-254-2777
Practice Address - Fax:661-253-2837
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG48510208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G485100Medicaid
CAA51084Medicare UPIN
CA00G485100Medicaid
CAG48510AMedicare PIN