Provider Demographics
NPI:1487895678
Name:BACA, SARAH K (PA-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:K
Last Name:BACA
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:23961 CALLE DE LA MAGDALENA
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3616
Mailing Address - Country:US
Mailing Address - Phone:949-770-0797
Mailing Address - Fax:949-770-0730
Practice Address - Street 1:23961 CALLE DE LA MAGDALENA
Practice Address - Street 2:SUITE 130
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3616
Practice Address - Country:US
Practice Address - Phone:949-770-0797
Practice Address - Fax:949-770-0730
Is Sole Proprietor?:No
Enumeration Date:2009-03-17
Last Update Date:2014-05-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA 20279363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant