Healthcare Provider Details

I. General information

NPI: 1053982165
Provider Name (Legal Business Name): SARA RISMILLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W CHASE AVE
EL CAJON CA
92020-5710
US

IV. Provider business mailing address

1331 COLUMBIA ST APT 1212
SAN DIEGO CA
92101-3777
US

V. Phone/Fax

Practice location:
  • Phone: 619-515-2499
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA59757
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: