Healthcare Provider Details

I. General information

NPI: 1023526506
Provider Name (Legal Business Name): SANDRA OGATO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18275 KENRICK AVE
LAKEVILLE MN
55044-7306
US

IV. Provider business mailing address

19131 HARAPPA AVE
LAKEVILLE MN
55044-4776
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12676
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: