Provider Demographics
NPI:1770982209
Name:SASAKI PICKARD, SUSAN KAZUMI (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:KAZUMI
Last Name:SASAKI PICKARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:KAZUMI
Other - Last Name:SASAKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-5900
Mailing Address - Fax:
Practice Address - Street 1:1520 SAN PABLO ST STE 1300
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5312
Practice Address - Country:US
Practice Address - Phone:323-442-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2024-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA52098363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant