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General NPI Number Information
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NPI Number | 1538233085
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Entity Type | Individual
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Provider Name | GAYLE KIKUMI SAKAGUCHI PA-C, PTA
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Gender | Female
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 12/27/2023
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Provider Practice Location Address
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Address Line | 1600 W AVENUE J
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City | LANCASTER
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State | CA
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Zip | 93534-2814
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Country | US
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Telephone | 661-949-5115
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Fax |
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Provider Business Mailing Address
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Address Line | 2139 W 166TH PL
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City | TORRANCE
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State | CA
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Zip | 90504-2244
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Country | US
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Telephone | 310-538-2880
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | AT 1215
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA 17174
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA 17174
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License Number State | CA
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