Healthcare Provider Details

I. General information

NPI: 1831780113
Provider Name (Legal Business Name): NOUR SARSANGI OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2021
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MINOR HALL
BERKELEY CA
94720-0001
US

IV. Provider business mailing address

200 MINOR HALL
BERKELEY CA
94720-0001
US

V. Phone/Fax

Practice location:
  • Phone: 510-642-2020
  • Fax:
Mailing address:
  • Phone: 510-642-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number36361
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: