Provider Demographics
NPI:1497787964
Name:SASANKA, JAROSLAW P (MD)
Entity Type:Individual
Prefix:
First Name:JAROSLAW
Middle Name:P
Last Name:SASANKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31685 TEMECULA PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-2872
Mailing Address - Country:US
Mailing Address - Phone:951-302-5700
Mailing Address - Fax:951-302-0555
Practice Address - Street 1:31685 TEMECULA PKWY STE B
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-2872
Practice Address - Country:US
Practice Address - Phone:951-302-5700
Practice Address - Fax:951-302-0555
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52304207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1497787964Medicaid
CA1497787964Medicaid