Individual
DR. RUSSELL LEONARD SANDBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1466 LINCOLN AVE, SAN RAFAEL, CA 94901-2021
(415) 457-3755
(415) 457-0849
Mailing address
433 THE ALAMEDA, SAN ANSELMO, CA 94960-1210
(415) 456-1649
(415) 456-1649
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
G26538
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G265381
—
CA
Enumeration date
10/14/2006
Last updated
12/01/2011
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