Provider Demographics
NPI:1801847082
Name:SAJADI, ALISA K (RN, CNM, FNP)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:K
Last Name:SAJADI
Suffix:
Gender:F
Credentials:RN, CNM, FNP
Other - Prefix:
Other - First Name:ALISA
Other - Middle Name:
Other - Last Name:SAJADI SMALLWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:24411 HEALTH CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3633
Mailing Address - Country:US
Mailing Address - Phone:949-829-5500
Mailing Address - Fax:949-581-9158
Practice Address - Street 1:24411 HEALTH CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3633
Practice Address - Country:US
Practice Address - Phone:949-829-5500
Practice Address - Fax:949-581-9158
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15751363L00000X
CANMW1690367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WNP15751AMedicare PIN