Provider Demographics
NPI:1538224274
Name:MCCOLL, SANDRA M (MD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:M
Last Name:MCCOLL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SANDRA
Other - Middle Name:MARIA , SANCHES
Other - Last Name:MCCOLL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4060 ALAMEDA DRIVE
Mailing Address - Street 2:
Mailing Address - City:SANDIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103
Mailing Address - Country:US
Mailing Address - Phone:619-269-7315
Mailing Address - Fax:
Practice Address - Street 1:651 WAKE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-9490
Practice Address - Country:US
Practice Address - Phone:760-352-2251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA525452080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine