Provider Demographics
NPI:1801829411
Name:SASAKI, ELIZABETH MIYO (DO)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MIYO
Last Name:SASAKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 W MURRAY AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-4970
Mailing Address - Country:US
Mailing Address - Phone:559-732-6414
Mailing Address - Fax:559-732-2909
Practice Address - Street 1:419 W MURRAY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4970
Practice Address - Country:US
Practice Address - Phone:559-732-6414
Practice Address - Fax:559-732-2909
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4991207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD43381Medicare ID - Type Unspecified