Provider Demographics
NPI:1821143165
Name:SARMIENTO, ENRICO L (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ENRICO
Middle Name:L
Last Name:SARMIENTO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11041 ICE SKATE PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4852
Mailing Address - Country:US
Mailing Address - Phone:858-547-9738
Mailing Address - Fax:
Practice Address - Street 1:BLDG 2496 BAUER RD
Practice Address - Street 2:BMC MIRAMAR
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92145
Practice Address - Country:US
Practice Address - Phone:858-577-9864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCPA# 1045348363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant