Individual
REUBEN MAKALA ANDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
461 7TH ST W STE 3, SONOMA, CA 95476-5976
(707) 938-1423
Mailing address
461 7TH ST W STE 3, SONOMA, CA 95476-5976
(707) 938-1423
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
A79025
CA
207N00000X
Dermatology Physician
MD-13554
HI
207N00000X
Dermatology Physician
MD00046746
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A790250
MEDICARE PTAN
CA
01
—
3298AN
BLUE SHIELD #
WA
01
—
7590826
AETNA#
WA
05
—
8463564
—
WA
Enumeration date
07/22/2006
Last updated
08/26/2020
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