Provider Demographics
NPI:1962578914
Name:SANFORD, MARK JOSEPH (MS, CCC-A)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JOSEPH
Last Name:SANFORD
Suffix:
Gender:
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 PANORAMIC WAY FL 1
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-1627
Mailing Address - Country:US
Mailing Address - Phone:925-938-8686
Mailing Address - Fax:
Practice Address - Street 1:31 PANORAMIC WAY FL 1
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94595-1627
Practice Address - Country:US
Practice Address - Phone:925-938-8686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
231H00000X
CAHA2506237600000X
CAAU1138237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
171779400OtherDEPT. OF LABOR
AU0011380OtherUNITED HEALTHCARE
CAAU0011380Medicaid
CAHA0025060OtherBLUE SHIELD OF CA