Provider Demographics
NPI:1548223266
Name:O'DONNELL, SANDRA ILEANA DIAZ (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:ILEANA DIAZ
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:401 S FAIR OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2603
Mailing Address - Country:US
Mailing Address - Phone:626-795-2244
Mailing Address - Fax:626-795-7441
Practice Address - Street 1:401 S FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2603
Practice Address - Country:US
Practice Address - Phone:626-795-2244
Practice Address - Fax:626-795-7441
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA13219363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant