Individual
IVAN ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3288 BELL RD, AUBURN, CA 95603
(530) 745-0700
(530) 745-0701
Mailing address
10470 OLD PLACERVILLE RD STE 100, SACRAMENTO, CA 95827-2539
(800) 470-0071
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
15988
NV
207RC0000X
Cardiovascular Disease Physician
Primary
A110448
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13566641
CAQH
—
05
—
1891960076
—
NV
Enumeration date
04/28/2008
Last updated
05/31/2019
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