Basic Information
| Provider Information | |||||||||
| NPI: | 1013097534 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SENDER | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D., IN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23823 VALENCIA BLVD STE 130 | ||||||||
| Address2: | |||||||||
| City: | SANTA CLARITA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913559513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612542777 | ||||||||
| FaxNumber: | 6612532837 | ||||||||
| Practice Location | |||||||||
| Address1: | 23823 VALENCIA BLVD STE 130 | ||||||||
| Address2: | |||||||||
| City: | SANTA CLARITA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913559513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612542777 | ||||||||
| FaxNumber: | 6612532837 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 01/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | G48510 | CA | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 00G485100 | 05 | CA | MEDICAID |