Healthcare Provider Details

I. General information

NPI: 1548800618
Provider Name (Legal Business Name): FATEMAH SARSAK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 10/29/2023
Certification Date: 10/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W STEWART DR STE 306
ORANGE CA
92868-3838
US

IV. Provider business mailing address

26024 ACERO
MISSION VIEJO CA
92691-2768
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: