Healthcare Provider Details

I. General information

NPI: 1386186302
Provider Name (Legal Business Name): LAURA SASSO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 REDWOOD HWY FRONTAGE RD STE 1204
MILL VALLEY CA
94941-2483
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 415-384-4778
  • Fax: 415-384-4779
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number02034949-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number55484
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: