Provider Demographics
NPI:1649323395
Name:STAROSTA, SARAH ELIZABETH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:ELIZABETH
Last Name:STAROSTA
Suffix:
Gender:F
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 1:153 PIONEER LN STE B
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-2517
Mailing Address - Country:US
Mailing Address - Phone:760-873-2849
Mailing Address - Fax:760-873-2836
Practice Address - Street 1:153 PIONEER LN STE B
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-2517
Practice Address - Country:US
Practice Address - Phone:760-873-2849
Practice Address - Fax:760-873-2836
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18706363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM08578FMedicaid
CA1205950888OtherFACILITY NPI
CA1659433191OtherORGANIZATION NPI NUMBER
CAOPA187061OtherMEDICARE PTAN
CA05-1324Medicare PIN
CA1659433191OtherORGANIZATION NPI NUMBER