Healthcare Provider Details

I. General information

NPI: 1548808827
Provider Name (Legal Business Name): SARAH FAITH DESLATE YAMANISHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH FAITH DESLATE

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 CAMPUS POINT DR
LA JOLLA CA
92037-1300
US

IV. Provider business mailing address

PO BOX 232410
SAN DIEGO CA
92193-2410
US

V. Phone/Fax

Practice location:
  • Phone: 858-249-6751
  • Fax:
Mailing address:
  • Phone: 800-926-8273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN290166
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95001538
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: