Provider Demographics
NPI:1083902217
Name:SARSAM, LENA ZAKI (PA-C)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:ZAKI
Last Name:SARSAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LENA
Other - Middle Name:ZAKI
Other - Last Name:JAMIL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:28544 CLEARVIEW ST
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-8606
Mailing Address - Country:US
Mailing Address - Phone:951-816-2465
Mailing Address - Fax:
Practice Address - Street 1:27450 YNEZ RD STE 109
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-4649
Practice Address - Country:US
Practice Address - Phone:951-587-0070
Practice Address - Fax:949-655-7878
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55353363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical