Basic Information
| Provider Information | |||||||||
| NPI: | 1023042322 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAW | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3626 RUFFIN RD | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921231810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585659666 | ||||||||
| FaxNumber: | 8585659441 | ||||||||
| Practice Location | |||||||||
| Address1: | 3626 RUFFIN RD | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921231810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585659666 | ||||||||
| FaxNumber: | 8585659441 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 12/07/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | A85916 | CA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP3000X | A85916 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pediatric Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 00A859160 | 05 | CA | MEDICAID | 00A859160 | 01 | CA | BLUE SHIELD OF CA | OTHER |