Provider Demographics
NPI:1871971580
Name:RIVERA SAGASTEGUI, MABEL DEL PILAR (PA-C)
Entity type:Individual
Prefix:
First Name:MABEL DEL PILAR
Middle Name:
Last Name:RIVERA SAGASTEGUI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 12TH ST STE 250
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-1929
Mailing Address - Country:US
Mailing Address - Phone:916-469-4690
Mailing Address - Fax:
Practice Address - Street 1:2433 MARCONI AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-4807
Practice Address - Country:US
Practice Address - Phone:916-737-5555
Practice Address - Fax:916-890-3828
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-13
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52446363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant