Sandberg, Russell Leonard

Sandberg, Russell Leonard is an sole proprietor health care provider with primary practice located at 1466 Lincoln Ave , San Rafael CA 94901-2021. He recently has only one registered license in Allopathic & Osteopathic Physicians / Addiction Medicine, which is considered as his primary health care specialty. Sandberg, Russell Leonard can be contacted via phone (415) 457-3755.

Contact Information

Primary practice address
1466 Lincoln Ave San Rafael CA 94901-2021
Phone: (415) 457-3755
Fax: (415) 457-0849
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Addiction Medicine 207RA0401X G26538 California

Profile Details

NPI number 1265522528
LBN Legal business name Sandberg, Russell Leonard
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 14th, 2006
Last updated Dec 1st, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265522528 NPPES
California MEDICAID 00G265381

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