Individual provider Active NPI

Sandra Blair Ekimoto, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Santa Ana, CA
National Provider Identifier
1134079809
Registry record updated May 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95038383 Issued in CA
Practice address
901 W Civic Center Dr Ste 200
Santa Ana, CA 92703-2383
Phone
(877) 515-8113
Fax
(877) 538-2102
NPI assigned
Feb 2, 2026
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 18, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 332703 AZ
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95038383 CA Primary

Addresses

Primary practice location

901 W Civic Center Dr Ste 200
Santa Ana, CA 92703-2383

Mailing address

901 W Civic Center Dr Ste 200
Santa Ana, CA 92703-2383
Phone (877) 515-8113

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260605002799 CA Practitioner - Nurse Practitioner 4486125846 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ehab Yacoub MD IncGroup PAC ID 5092099523, 179 clinicians

Practice addresses (Care Compare)

1225 W 190TH St
Suite 280
Gardena, CA 90248-4305
Phone (877) 515-8113

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
332703AZMDPsychiatric/Mental Health Nurse Practitioner
95038383CAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ehab Yacoub MD Inc. CurrentSince May 21, 2026 Accepting new patients

Locations

10601 Walker St
Cypress, CA 90630
Phone (714) 656-2130

1225 W 190th St
Ste 280
Gardena, CA 90248
Phone (310) 515-8113

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1769990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779062400000",
    "number": "1134079809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 W CIVIC CENTER DR STE 200",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927032383",
            "telephone_number": "877-515-8113",
            "fax_number": "877-538-2102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 W CIVIC CENTER DR STE 200",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927032383",
            "telephone_number": "877-515-8113",
            "fax_number": "877-538-2102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EKIMOTO",
        "first_name": "SANDRA",
        "middle_name": "BLAIR",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-02-02",
        "last_updated": "2026-05-18",
        "certification_date": "2026-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "332703",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95038383",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Ana, CA

Sources for this page

Verify at the official NPI Registry.