Provider Demographics
NPI:1356541676
Name:SANDERS, RITA G (MSN, CNM)
Entity type:Individual
Prefix:MRS
First Name:RITA
Middle Name:G
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MSN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6395 ESCENA ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-5136
Mailing Address - Country:US
Mailing Address - Phone:909-880-1982
Mailing Address - Fax:909-881-4215
Practice Address - Street 1:249 E HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3707
Practice Address - Country:US
Practice Address - Phone:909-881-1683
Practice Address - Fax:909-881-4215
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANMW1092176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife