Provider Demographics
NPI:1982133591
Name:SACKS, BRENT A (CRNA)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:A
Last Name:SACKS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25033
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92799-5033
Mailing Address - Country:US
Mailing Address - Phone:714-347-1000
Mailing Address - Fax:714-347-1082
Practice Address - Street 1:9001 WILSHIRE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1840
Practice Address - Country:US
Practice Address - Phone:310-275-2339
Practice Address - Fax:310-275-2357
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112008367500000X
TXAP134142367500000X
CA95001445367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered