Provider Demographics
NPI:1780624825
Name:SANDERS, CRAIG C (PA)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:C
Last Name:SANDERS
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14650 AVIATION BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-6667
Mailing Address - Country:US
Mailing Address - Phone:323-306-9632
Mailing Address - Fax:323-268-6738
Practice Address - Street 1:1180 N INDIAN CANYON DR STE 311
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4858
Practice Address - Country:US
Practice Address - Phone:323-306-9632
Practice Address - Fax:323-268-6738
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15233363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPA182330Medicaid
CAOPA182330Medicaid