1104442011 NPI number — MS. SARAH ELISABETH MACMILLAN DPT

Table of content: MS. SARAH ELISABETH MACMILLAN DPT (NPI 1104442011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104442011 NPI number — MS. SARAH ELISABETH MACMILLAN DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACMILLAN
Provider First Name:
SARAH
Provider Middle Name:
ELISABETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104442011
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23521 PASEO DE VALENCIA
Provider Second Line Business Mailing Address:
SUITE B7
Provider Business Mailing Address City Name:
LAGUNA BILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92653-3014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-597-0007
Provider Business Mailing Address Fax Number:
949-597-0040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30100 TOWNE CENTER DRIVE
Provider Second Line Business Practice Location Address:
SUITE YZ
Provider Business Practice Location Address City Name:
LAGUNA NIGUEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92677-2064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-597-0007
Provider Business Practice Location Address Fax Number:
949-597-0040
Provider Enumeration Date:
06/17/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT297968 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com