DR. RUSSELL LEONARD SANDBERG (NPI# 1265522528) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265522528 |
| Entity Type | Individual |
| Full Name | DR. RUSSELL LEONARD SANDBERG |
| Credential | MD |
| Practice Address |
1466 Lincoln Ave San Rafael CA 94901-2021 |
| Mailing Address |
433 The Alameda San Anselmo CA 94960-1210 |
| Practice Telephone | 4154573755 |
| Practice Fax Number | 4154570849 |
| Mailing Telephone | 4154561649 |
| Mailing Fax Number | 4154561649 |
| Enumeration Date | 2006-10-14 |
| Last Update Date | 2011-12-01 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RA0401X |
Internal Medicine Specialization: Addiction Medicine |
G26538 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00G265381 | 05 |
| Street Address |
1466 LINCOLN AVE |
| City | SAN RAFAEL |
| State | CA |
| Zip Code | 94901-2021 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811523046 | Gabriela Liliana Lara | Counselor | 1466 Lincoln Ave, San Rafael, CA 94901-2021 | 2020-03-19 |
| 1649805300 | Alexis Soria | Counselor | 1466 Lincoln Ave, San Rafael, CA 94901-2021 | 2020-03-03 |
| 1821640913 | Rajena Laffey | Counselor | 1466 Lincoln Ave, San Rafael, CA 94901-2021 | 2019-07-10 |
| 1932688033 | Jonathan Alexander Cantu | Counselor | 1466 Lincoln Ave, San Rafael, CA 94901-2021 | 2018-08-09 |
| 1568966737 | Christina Marie Chavez | Licensed Vocational Nurse | 1466 Lincoln Ave, San Rafael, CA 94901-2021 | 2018-03-21 |
| 1679000442 | Edelyn Panaligan | Licensed Vocational Nurse | 1466 Lincoln Ave, San Rafael, CA 94901-2021 | 2017-05-11 |
| 1023559028 | Lavenia Brown | Counselor | 1466 Lincoln Ave, San Rafael, CA 94901-2021 | 2017-03-10 |
| 1255877577 | Sharon Forsythe | Counselor | 1466 Lincoln Ave, San Rafael, CA 94901-2021 | 2017-01-10 |
| 1194260877 | Jessica Kostelic | Counselor | 1466 Lincoln Ave, San Rafael, CA 94901-2021 | 2017-01-04 |
| 1639627144 | Linna Kong | Marriage & Family Therapist | 1466 Lincoln Ave, San Rafael, CA 94901-2021 | 2016-09-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780207134 | Marianne Haissman Stefancic | Marriage & Family Therapist | 409 Forbes Ave., San Rafael, CA 94901 | 2020-05-20 |
| 1093292765 | Marin Community Clinic | Clinic/Center | 411 4th Strteet, Suite A, San Rafael, CA 94901 | 2018-07-25 |
| 1275052516 | Laura Ellen Silverstein | Marriage & Family Therapist | 600 Fifth Avenue, San Rafael, CA 94901 | 2017-09-19 |
| 1689101107 | Marin Family Recovery | Clinic/Center | 1209 Third St. Ste 4, San Rafael, CA 94901 | 2017-05-15 |
| 1376070011 | Tencia Beavers-sanchez | Counselor | 710 C Street Suite#8, Marin Outpatient&recoveryservices, Sanrafael, CA 94901 | 2017-05-12 |
| 1326584905 | Jamie Waterman | Emergency Medical Technician, Basic | 675 Sir Francis Drake Blvd, Kentfield, CA 94901 | 2017-01-06 |
| 1295270676 | Stephen Marks | Counselor | 900 Fifth Avenue, Suite 150, ; San Rafael, CA 94901 | 2016-12-21 |
| 1497299812 | Vesna Sturman | Psychologist | 712 D St Ste L, San Rafael, CA 94901 | 2016-12-05 |
| 1063955771 | Carol Dutton Hollenberg | Behavior Technician | 503 D St., San Rafael, CA 94901 | 2016-11-29 |
| 1083069447 | Bay Area Community Resources | Community/Behavioral Health | 103 Shoreline Parkway, San Rafael, CA 94901 | 2016-05-04 |
| Find all providers in zip 94901 | ||||
| Taxonomy Code | 207RA0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Addiction Medicine |
| An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902458540 | Medicus Telehealth Inc. | Internal Medicine | 180 N Rexford Dr, Beverly Hills, CA 90210-5406 | 2019-07-13 |
| 1962978114 | Samer Moghaddam Md, Apc | Internal Medicine | 902 N Grand Ave Ste 201, Santa Ana, CA 92701-4218 | 2018-10-15 |
| 1972009785 | William Supplee | Internal Medicine | 151 Calderon Ave Apt 96, Mountain View, CA 94041-1433 | 2018-04-02 |
| 1245767516 | Chemical Dependency Treatment Associates, Inc | Internal Medicine | 455 University Ave Ste 320, Sacramento, CA 95825-6580 | 2017-05-17 |
| 1568917367 | Mjc Hospitalist Group, Inc. | Internal Medicine | 4615 Lemona Ave, Sherman Oaks, CA 91403-2428 | 2016-08-22 |
| 1073962171 | Faried Banimahd Md Inc | Internal Medicine | 1533 E 4th St Ste 4, Santa Ana, CA 92701-5115 | 2016-06-09 |
| 1467827683 | 360 Recovery Inc | Internal Medicine | 23986 Aliso Creek Rd Ste 226, Laguna Niguel, CA 92677-3908 | 2015-12-14 |
| 1841665254 | Kpg California, LLC | Internal Medicine | 9000 W Sunset Blvd Ste 1500, West Hollywood, CA 90069-5815 | 2015-12-10 |
| 1780050278 | Craig V. Smith, M.d., A Professional Medical Corporation | Internal Medicine | 6711 Melrose Ave., Los Angeles, CA 90038 | 2015-08-19 |
| 1730561861 | Synergy Lifestyle Center, Inc. | Internal Medicine | 7910 Downing Ave Ste 200, Bakersfield, CA 93308-5016 | 2015-06-25 |
| Find all providers with the same taxonomy | ||||
| City | SAN RAFAEL |
| Zip Code | 94901 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.