Basic Information
| Provider Information | |||||||||
| NPI: | 1316355605 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TEBSHERANI | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | AKIKI | ||||||||
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| Credential: | PA -C | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | AKIKI | ||||||||
| OtherFirstName: | SARAH | ||||||||
| OtherMiddleName: | T | ||||||||
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| OtherCredential: | PA-C | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9898 GENESEE AVE | ||||||||
| Address2: | |||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920371205 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 10666 N TORREY PINES RD # 2W | ||||||||
| Address2: | |||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585543300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2014 | ||||||||
| LastUpdateDate: | 08/21/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 53308 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.