Healthcare Provider Details

I. General information

NPI: 1720002058
Provider Name (Legal Business Name): SARMISTHA KUMAR DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 CEDAR RD
VISTA CA
92083-5102
US

IV. Provider business mailing address

10170 SORRENTO VALLEY RD
SAN DIEGO CA
92121-1604
US

V. Phone/Fax

Practice location:
  • Phone: 760-806-5890
  • Fax:
Mailing address:
  • Phone: 760-806-5890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number20A8250
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number20A8250
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: