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General NPI Number Information
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NPI Number | 1902623440
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Entity Type | Organization
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Legal Business Name | PURPLE SAGE PSYCHIATRY, INC.
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Dates
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Enumeration Date | 09/25/2024
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 3830 VALLEY CENTRE DR STE 705-821
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City | SAN DIEGO
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State | CA
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Zip | 92130-3320
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Country | US
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Telephone | 858-215-2349
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Fax | 858-614-7572
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Provider Business Mailing Address
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Address Line | 3830 VALLEY CENTRE DR STE 705-821
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City | SAN DIEGO
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State | CA
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Zip | 92130-3320
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Country | US
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Telephone | 858-215-2349
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. MINA LYNN SARDASHTI
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Credential | MD
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Telephone | 858-215-2349
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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