Provider Demographics
NPI:1407868169
Name:SARMIENTO, KATHLEEN FUMIKO (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:FUMIKO
Last Name:SARMIENTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:FUMIKO
Other - Last Name:BRENNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3350 LA JOLLA VILLAGE DR
Mailing Address - Street 2:MAIL CODE 111J
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92161-0002
Mailing Address - Country:US
Mailing Address - Phone:858-552-8585
Mailing Address - Fax:858-546-1754
Practice Address - Street 1:3350 LA JOLLA VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161-0002
Practice Address - Country:US
Practice Address - Phone:858-552-8585
Practice Address - Fax:858-546-1754
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0064792207R00000X
MDD64792207RC0200X, 207RP1001X
CAA117503207RS0012X, 207RP1001X, 207RC0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS062-0353OtherBLUE CROSS/BLUE SHIELD - REGIONAL
MD895016-02 & 03OtherBLUE CROSS/BLUE SHIELD
MD417537900Medicaid
MD417537900Medicaid
MD895016-02 & 03OtherBLUE CROSS/BLUE SHIELD