Healthcare Provider Details

I. General information

NPI: 1679012678
Provider Name (Legal Business Name): MICHELLE SAKAUE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE SIMBULAN

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13855 E 14TH ST
SAN LEANDRO CA
94578-2611
US

IV. Provider business mailing address

13855 E 14TH ST
SAN LEANDRO CA
94578-2611
US

V. Phone/Fax

Practice location:
  • Phone: 510-667-4545
  • Fax:
Mailing address:
  • Phone: 831-345-5032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number54132
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: