Basic Information
| Provider Information | |||||||||
| NPI: | 1477640944 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUNBRASKY | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1219 SW 4TH AVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | ONTARIO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418892668 | ||||||||
| FaxNumber: | 5418892997 | ||||||||
| Practice Location | |||||||||
| Address1: | 1219 SW 4TH AVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | ONTARIO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418892668 | ||||||||
| FaxNumber: | 5418892997 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2006 | ||||||||
| LastUpdateDate: | 09/29/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD17772 | OR | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 048962 | 05 | OR | MEDICAID | 000010005327 | 01 | ID | BLUE SHIELD OF ID | OTHER | 055336002 | 01 | OR | BLUE CROSS OF OREGON | OTHER | 1040301 | 01 | PACIFIC SOURCE | OTHER | 003424800 | 05 | ID | MEDICAID |