Provider Demographics
NPI:1952361412
Name:SANDEN, RODERICK G S (MD)
Entity type:Individual
Prefix:
First Name:RODERICK
Middle Name:G S
Last Name:SANDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3609 MISSION AVE
Mailing Address - Street 2:STE F
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-2955
Mailing Address - Country:US
Mailing Address - Phone:916-484-4444
Mailing Address - Fax:916-484-4447
Practice Address - Street 1:3609 MISSION AVE
Practice Address - Street 2:STE F
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-2955
Practice Address - Country:US
Practice Address - Phone:916-484-4444
Practice Address - Fax:916-484-4447
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42245204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2229523Medicaid
CAG42245OtherSTATE LICENCE NUMBER
CA2229523Medicaid