Provider Demographics
NPI:1417138538
Name:HOLLY SATA MD , PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:HOLLY SATA MD , PROFESSIONAL CORPORATION
Other - Org Name:DR HOLLY SATA
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-600-6760
Mailing Address - Street 1:277 MORNING CANYON RD
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-2641
Mailing Address - Country:US
Mailing Address - Phone:714-600-6760
Mailing Address - Fax:949-720-0337
Practice Address - Street 1:20201 SW BIRCH ST STE 100
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1781
Practice Address - Country:US
Practice Address - Phone:714-935-9500
Practice Address - Fax:714-935-9559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG71823OtherMEDICARE ID UNSPECIFIED
CAG71823Medicaid
CA00G718230Medicaid