Basic Information
| Provider Information | |||||||||
| NPI: | 1427431477 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPEARE | ||||||||
| FirstName: | SASHA | ||||||||
| MiddleName: | DANIEL | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26902 OSO PKWY STE 120 | ||||||||
| Address2: | |||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926915801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493649595 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 26902 OSO PKWY STE 120 | ||||||||
| Address2: | |||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926915801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493649595 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2015 | ||||||||
| LastUpdateDate: | 01/29/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 22687052 | NY | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 95004320 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 163W00000X | 95090648 | CA | N | Nursing Service Providers | Registered Nurse |
No ID Information.