=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811266117
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SARAH Z. MINASYAN MD, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2011
-----------------------------------------------------
Last Update Date | 06/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3010 BEARD RD
-----------------------------------------------------
City | NAPA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94558-3442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-255-8825
-----------------------------------------------------
Fax | 707-252-9325
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1261 TRAVIS BLVD SUITE 200
-----------------------------------------------------
City | FAIRFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94533-4897
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-501-9831
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SARAH Z MINASYAN
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 714-501-9831
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208G00000X
-----------------------------------------------------
Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
-----------------------------------------------------
License Number | A82064
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------