Provider Demographics
NPI:1780600486
Name:STANTON, SARAH ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:ELIZABETH
Last Name:STANTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SPRING BUCK
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-7431
Mailing Address - Country:US
Mailing Address - Phone:858-829-5407
Mailing Address - Fax:949-679-7408
Practice Address - Street 1:9 SPRING BUCK
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-7431
Practice Address - Country:US
Practice Address - Phone:858-829-5407
Practice Address - Fax:949-679-7408
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79771208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB213866Medicare UPIN
CA00G797710Medicaid
CAG79771Medicare ID - Type Unspecified