Provider Demographics
NPI:1194757880
Name:SANDQUIST, MARK ATARIUS (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ATARIUS
Last Name:SANDQUIST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:155 BIG CANYON CT
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-5101
Mailing Address - Country:US
Mailing Address - Phone:805-473-4643
Mailing Address - Fax:
Practice Address - Street 1:117 W BUNNY AVE
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-2805
Practice Address - Country:US
Practice Address - Phone:805-739-3890
Practice Address - Fax:805-347-7697
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG86739207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G867390Medicaid
CAWG86739AMedicare PIN
CA00G867390Medicaid