Provider Demographics
NPI:1376513168
Name:JASSMANN, SANDRA LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LEE
Last Name:JASSMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5565 GROSSMONT CENTER DR BLDG 3
Mailing Address - Street 2:SUITE 360
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942
Mailing Address - Country:US
Mailing Address - Phone:619-462-3360
Mailing Address - Fax:619-462-3363
Practice Address - Street 1:5565 GROSSMONT CENTER DR BLDG 3
Practice Address - Street 2:SUITE 360
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942
Practice Address - Country:US
Practice Address - Phone:619-462-3360
Practice Address - Fax:619-462-3363
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27383207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G273830Medicaid
CAG27383Medicare ID - Type Unspecified
CA00G273830Medicaid