=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992878151
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ULIN SARGEANT M.D., MPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2006
-----------------------------------------------------
Last Update Date | 10/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1227 BUENA VISTA ST SUITE #F
-----------------------------------------------------
City | DUARTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91010-2486
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-254-4496
-----------------------------------------------------
Fax | 877-254-4496
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2063
-----------------------------------------------------
City | MONROVIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91017-6063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-254-4496
-----------------------------------------------------
Fax | 877-254-4496
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2083P0901X
-----------------------------------------------------
Taxonomy Name | Public Health & General Preventive Medicine Physician
-----------------------------------------------------
License Number | A97256
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | A97256
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | A97256
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------