Provider Demographics
NPI:1841250974
Name:MATHUR, SANDRA A (DO)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:A
Last Name:MATHUR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1514 VALLEY VISTA DR
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3929
Mailing Address - Country:US
Mailing Address - Phone:909-860-1144
Mailing Address - Fax:909-860-3526
Practice Address - Street 1:1514 VALLEY VISTA DR
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3929
Practice Address - Country:US
Practice Address - Phone:909-860-1144
Practice Address - Fax:909-860-3526
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A6905208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH29228Medicare UPIN
CAEG382YMedicare PIN