Provider Demographics
NPI:1194117135
Name:MACISAAC, SARAH JEAN
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JEAN
Last Name:MACISAAC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5199 E PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 324
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3309
Mailing Address - Country:US
Mailing Address - Phone:562-597-1152
Mailing Address - Fax:866-825-4275
Practice Address - Street 1:5199 E PACIFIC COAST HWY
Practice Address - Street 2:SUITE 324
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3309
Practice Address - Country:US
Practice Address - Phone:562-597-1152
Practice Address - Fax:866-825-4275
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABU21426050376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker