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General NPI Number Information
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NPI Number | 1396497087
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Entity Type | Individual
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Provider Name | SALLY SAYASA NP
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Gender | Female
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Dates
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Enumeration Date | 01/24/2022
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Last Update Date | 01/24/2022
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Provider Practice Location Address
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Address Line | 9940 TALBERT AVE # 101
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-5153
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Country | US
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Telephone | 949-872-5699
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Fax |
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Provider Business Mailing Address
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Address Line | 8411 ASPENWOOD AVE
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City | WESTMINSTER
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State | CA
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Zip | 92683-6378
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Country | US
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Telephone | 714-514-0773
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 95019815
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License Number State | CA
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