Healthcare Provider Details

I. General information

NPI: 1295057735
Provider Name (Legal Business Name): SANDRA KAREN OVADIA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2010
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SUPERIOR AVE SUITE 225
NEWPORT BEACH CA
92663-3637
US

IV. Provider business mailing address

520 SUPERIOR AVE SUITE 225
NEWPORT BEACH CA
92663-3637
US

V. Phone/Fax

Practice location:
  • Phone: 949-360-0300
  • Fax:
Mailing address:
  • Phone: 949-360-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number21141
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: