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NPI Code Detail

MEDICARE: MRS. SANDRA ILEANA DIAZ O'DONNELL PA-C

MEDICARE: MRS. SANDRA ILEANA DIAZ O'DONNELL PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA13219CA

General Provider Information

NPI Number : 1548223266
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SANDRA ILEANA DIAZ O'DONNELL PA-C
Provider Business Mailing Address
First Line : 401 S FAIR OAKS AVE
Second Line :
City : PASADENA
State : CA
Zip : 91105-2603
Country : US
Telephone Number : 626-795-2244
Fax Number : 626-795-7441
Provider Business Practice Location Address
First Line : 401 S FAIR OAKS AVE
Second Line :
City : PASADENA
State : CA
Zip : 91105-2603
Country : US
Telephone Number : 626-795-2244
Fax Number : 626-795-7441
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2006
Last Update Date : 08/19/2022

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