Individual
MATILDA SANDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1810 EUCLID ST, BEAUMONT, TX 77705-1815
(409) 658-4662
Mailing address
4895 GARWOOD LN, BEAUMONT, TX 77706-2736
(409) 658-4662
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
873251025
—
TX
Enumeration date
12/10/2021
Last updated
12/10/2021
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