Provider Demographics
NPI:1134426836
Name:SARA GASPARD, M.D., INC.
Entity type:Organization
Organization Name:SARA GASPARD, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:GASPARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-793-7790
Mailing Address - Street 1:960 E GREEN ST STE 164
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2405
Mailing Address - Country:US
Mailing Address - Phone:626-793-7790
Mailing Address - Fax:626-793-9018
Practice Address - Street 1:960 E GREEN ST STE 164
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2405
Practice Address - Country:US
Practice Address - Phone:626-793-7790
Practice Address - Fax:626-793-9018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97252174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW7406Medicare UPIN