Provider Demographics
NPI:1174747752
Name:SACRAMENTO, EARL ARMANDO JARANILLA (PA-C)
Entity type:Individual
Prefix:MR
First Name:EARL
Middle Name:ARMANDO JARANILLA
Last Name:SACRAMENTO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:EARL
Other - Middle Name:JARANILLA
Other - Last Name:SACRAMENTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:17133 RUSSET ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-2190
Mailing Address - Country:US
Mailing Address - Phone:858-674-4611
Mailing Address - Fax:
Practice Address - Street 1:4647 ZION AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-2507
Practice Address - Country:US
Practice Address - Phone:619-528-5441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13233363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant