Healthcare Provider Details

I. General information

NPI: 1255577888
Provider Name (Legal Business Name): SARA A CAAN VAN LEEUWEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA ALEXANDRA CAAN PA-C

II. Dates (important events)

Enumeration Date: 01/03/2009
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10100 CULVER BLVD STE E
CULVER CITY CA
90232-3174
US

IV. Provider business mailing address

4140 W 190TH ST
TORRANCE CA
90504-5513
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-3333
  • Fax: 310-423-1300
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA19771
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: