Healthcare Provider Details

I. General information

NPI: 1790424364
Provider Name (Legal Business Name): STEFANIE SARMIENTO DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 01/04/2023
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24050 ALISO CREEK RD STE 1C
LAGUNA NIGUEL CA
92677-3937
US

IV. Provider business mailing address

29246 CHINKAPIN
LAKE ELSINORE CA
92530-4412
US

V. Phone/Fax

Practice location:
  • Phone: 949-317-4454
  • Fax:
Mailing address:
  • Phone: 714-553-0323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: