MEDICARE: CHRISTINE ELIZABETH SARASUA

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
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1952606915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE ELIZABETH SARASUA

Provider Business Mailing Address
First Line	:	5560 OVERLAND AVE.
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123
Country	:	US
Telephone Number	:	619-542-4051
Fax Number	:

Provider Business Practice Location Address
First Line	:	5560 OVERLAND AVE.
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1206
Country	:	US
Telephone Number	:	619-542-4051
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2011
Last Update Date	:	01/21/2011

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