Healthcare Provider Details

I. General information

NPI: 1134426836
Provider Name (Legal Business Name): SARA GASPARD, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2011
Last Update Date: 02/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 E GREEN ST STE 164
PASADENA CA
91106-2405
US

IV. Provider business mailing address

960 E GREEN ST STE 164
PASADENA CA
91106-2405
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-7790
  • Fax: 626-793-9018
Mailing address:
  • Phone: 626-793-7790
  • Fax: 626-793-9018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA97252
License Number StateCA

VIII. Authorized Official

Name: DR. SARA Y GASPARD
Title or Position: OWNER
Credential: M.D.
Phone: 626-793-7790