Healthcare Provider Details

I. General information

NPI: 1841612710
Provider Name (Legal Business Name): SASHA CARRANZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2014
Last Update Date: 01/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 E 3RD ST
LONG BEACH CA
90814-2520
US

IV. Provider business mailing address

3125 E 3RD ST
LONG BEACH CA
90814-2520
US

V. Phone/Fax

Practice location:
  • Phone: 714-893-7399
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSPA2538
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: