Provider Demographics
NPI:1649213307
Name:SAGRAMOSO, KARLA ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:KARLA
Middle Name:ANN
Last Name:SAGRAMOSO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 53RD ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1814
Mailing Address - Country:US
Mailing Address - Phone:510-459-6893
Mailing Address - Fax:
Practice Address - Street 1:770 53RD ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1814
Practice Address - Country:US
Practice Address - Phone:510-459-6893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14104103TC2200X
CAPSY14104103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL141040OtherBLUE SHIELD
CA76083OtherMHN
CAHSP40611FMedicaid
O53301Medicare UPIN
O53301Medicare ID - Type Unspecified