Provider Demographics
NPI:1548350366
Name:SANDERS, GEORGE H (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:H
Last Name:SANDERS
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 1:16633 VENTURA BLVD
Mailing Address - Street 2:#110
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436
Mailing Address - Country:US
Mailing Address - Phone:818-981-3333
Mailing Address - Fax:818-981-0249
Practice Address - Street 1:16633 VENTURA BLVD
Practice Address - Street 2:#110
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91426
Practice Address - Country:US
Practice Address - Phone:818-981-3333
Practice Address - Fax:818-981-0249
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42048208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A48791Medicare UPIN
G42048Medicare ID - Type Unspecified