Healthcare Provider Details

I. General information

NPI: 1952344640
Provider Name (Legal Business Name): BIG SUR MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18800 DELAWARE ST STE 100
HUNTINGTON BEACH CA
92648-6082
US

IV. Provider business mailing address

18800 DELAWARE ST STE 100
HUNTINGTON BEACH CA
92648-6082
US

V. Phone/Fax

Practice location:
  • Phone: 714-707-3314
  • Fax: 714-707-3374
Mailing address:
  • Phone: 714-707-3314
  • Fax: 714-707-3374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA94411
License Number StateCA

VIII. Authorized Official

Name: DR. SARAH KAY VAKKALANKA
Title or Position: PROVIDER
Credential: MD
Phone: 714-375-5780