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General NPI Number Information
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NPI Number | 1861601437
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Entity Type | Individual
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Provider Name | SUKUMARN SARAH MINGVIRIYA MSHS, PA-C, ATRET
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Gender | Female
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 39400 PASEO PADRE PKWY
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City | FREMONT
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State | CA
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Zip | 94538-2310
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Country | US
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Telephone | 510-248-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 41492 ALICE ST
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City | FREMONT
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State | CA
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Zip | 94539-4533
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Country | US
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Telephone | 510-396-5134
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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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 | 015283
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 53437
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License Number State | CA
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