Provider Demographics
NPI:1205138492
Name:SADALGE, MYRNA (MEDICAL ASSISTANT)
Entity type:Individual
Prefix:
First Name:MYRNA
Middle Name:
Last Name:SADALGE
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:MYRNA
Other - Middle Name:
Other - Last Name:SADALGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MEDICAL ASSISTANT
Mailing Address - Street 1:7405 CHARMANT DR
Mailing Address - Street 2:UNIT 2402
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-4715
Mailing Address - Country:US
Mailing Address - Phone:562-787-4919
Mailing Address - Fax:
Practice Address - Street 1:7405 CHARMANT DR
Practice Address - Street 2:UNIT 2402
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-4715
Practice Address - Country:US
Practice Address - Phone:562-787-4919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA181506171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider