Healthcare Provider Details

I. General information

NPI: 1447617832
Provider Name (Legal Business Name): KARLENE SARRISIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2016
Last Update Date: 01/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 GROSSMONT CENTER DR
LA MESA CA
91942-3019
US

IV. Provider business mailing address

PO BOX 502536
SAN DIEGO CA
92150-2536
US

V. Phone/Fax

Practice location:
  • Phone: 619-740-4451
  • Fax: 619-740-4354
Mailing address:
  • Phone: 858-449-9475
  • Fax: 619-740-4354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number38344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: