Basic Information
| Provider Information | |||||||||
| NPI: | 1235542531 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FATIMA | ||||||||
| FirstName: | SANNA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 DISTEL CIR | ||||||||
| Address2: | |||||||||
| City: | LOS ALTOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940221408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9257563400 | ||||||||
| FaxNumber: | 5105067728 | ||||||||
| Practice Location | |||||||||
| Address1: | 4053 LONE TREE WAY STE 201 | ||||||||
| Address2: | |||||||||
| City: | ANTIOCH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945316210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9255132483 | ||||||||
| FaxNumber: | 9255138226 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2014 | ||||||||
| LastUpdateDate: | 01/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | MT205904 | PA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | MD461484 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 1117881 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | A154332 | 01 | CA | STATE MEDICAL LICENSE | OTHER |