Provider Demographics
NPI:1932693249
Name:LIGHTFOOT, SASHA L (DO)
Entity Type:Individual
Prefix:DR
First Name:SASHA
Middle Name:L
Last Name:LIGHTFOOT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:SASHA
Other - Middle Name:L
Other - Last Name:HORNOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:5005 N. PIEDRAS ST
Mailing Address - Street 2:ATTN: MCHM-DOS-GSR
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920-5001
Mailing Address - Country:US
Mailing Address - Phone:915-742-2698
Mailing Address - Fax:915-742-7889
Practice Address - Street 1:18511 HIGHLANDER MEDICS ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79906-5327
Practice Address - Country:US
Practice Address - Phone:915-742-0730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X
NEOS020369208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No171000000XOther Service ProvidersMilitary Health Care Provider