Provider Demographics
NPI:1255352852
Name:SANDERS, MIA JE NAEE (MD)
Entity type:Individual
Prefix:DR
First Name:MIA
Middle Name:JE NAEE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MIA
Other - Middle Name:JE NAEE
Other - Last Name:SANDERS MADATI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:21311 MADRONA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-5970
Mailing Address - Country:US
Mailing Address - Phone:310-792-4010
Mailing Address - Fax:310-792-4093
Practice Address - Street 1:20911 EARL ST STE 440
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4355
Practice Address - Country:US
Practice Address - Phone:310-419-8585
Practice Address - Fax:310-419-8553
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236176207VX0000X
CAA98270207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics