Provider Demographics
NPI:1275362360
Name:MIHALKO, SARASOTA
Entity type:Individual
Prefix:
First Name:SARASOTA
Middle Name:
Last Name:MIHALKO
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 1:9255 N MAGNOLIA AVE SPC 46
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-3139
Mailing Address - Country:US
Mailing Address - Phone:407-864-2616
Mailing Address - Fax:
Practice Address - Street 1:4401 MANCHESTER AVE STE 103
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4938
Practice Address - Country:US
Practice Address - Phone:760-606-9189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64306363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant