Provider Demographics
NPI:1174331466
Name:MUHTASEB, SARA TALAL (PA-C)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:TALAL
Last Name:MUHTASEB
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:43575 MISSION BLVD STE 716
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-5831
Mailing Address - Country:US
Mailing Address - Phone:360-940-0880
Mailing Address - Fax:844-697-8702
Practice Address - Street 1:1152 DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2452
Practice Address - Country:US
Practice Address - Phone:760-681-3444
Practice Address - Fax:844-697-8702
Is Sole Proprietor?:No
Enumeration Date:2024-12-19
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPA61646078363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant