Healthcare Provider Details

I. General information

NPI: 1881047892
Provider Name (Legal Business Name): SARAH KANTELIS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH ALBU PA

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26024 ACERO
MISSION VIEJO CA
92691-2768
US

IV. Provider business mailing address

19782 MACARTHUR BLVD STE 300
IRVINE CA
92612-2417
US

V. Phone/Fax

Practice location:
  • Phone: 714-545-5550
  • Fax: 949-609-0374
Mailing address:
  • Phone: 714-545-5550
  • Fax: 714-708-2588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA53960
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberPA53960
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: