Provider Demographics
NPI:1720405889
Name:KASMAN, SARAH
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:KASMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23461 SOUTH POINTE DRIVE
Mailing Address - Street 2:100
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653
Mailing Address - Country:US
Mailing Address - Phone:949-452-0888
Mailing Address - Fax:949-452-0889
Practice Address - Street 1:23461 S POINTE DR
Practice Address - Street 2:100
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1547
Practice Address - Country:US
Practice Address - Phone:949-452-0888
Practice Address - Fax:949-452-0889
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33-0236592OtherFEDERAL TAX IDENTIFICATION