Basic Information
| Provider Information | |||||||||
| NPI: | 1336871094 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONNOR | ||||||||
| FirstName: | SASHA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 631277 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452631277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584280222 | ||||||||
| FaxNumber: | 8583453341 | ||||||||
| Practice Location | |||||||||
| Address1: | 4200 ROCKLIN RD STE 11B | ||||||||
| Address2: | |||||||||
| City: | ROCKLIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956772860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584280222 | ||||||||
| FaxNumber: | 8583453341 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2022 | ||||||||
| LastUpdateDate: | 06/30/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | CA | Y |
No ID Information.