Individual provider Active NPI

Mina Lynn Sardashti, M.D.

  • Psychiatry Physician
  • San Diego, CA
National Provider Identifier
1467985499
Registry record updated Feb 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
172248 Issued in CA
Practice address
3830 Valley Centre Dr Ste 705-821
San Diego, CA 92130-3320
Phone
(858) 215-2349
Fax
(858) 614-7572
NPI assigned
Apr 6, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 11, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 172248 CA Primary

Addresses

Primary practice location

3830 Valley Centre Dr Ste 705-821
San Diego, CA 92130-3320

Mailing address

3830 Valley Centre Dr Ste 705-821
San Diego, CA 92130-3320
Phone (858) 215-2349

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220223001281 CA Practitioner - Psychiatry 1456622646

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
172248CAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Purple Sage Psychiatry, Inc. Psychiatry CurrentSince Feb 23, 2025 Accepting new patients

Locations

3830 Valley Centre Dr
Ste 705821
San Diego, CA 92130
Phone (858) 215-2349

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": "1491436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739232000000",
    "number": "1467985499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3830 VALLEY CENTRE DR STE 705-821",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921303320",
            "telephone_number": "858-215-2349",
            "fax_number": "858-614-7572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3830 VALLEY CENTRE DR STE 705-821",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921303320",
            "telephone_number": "858-215-2349",
            "fax_number": "858-614-7572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SARDASHTI",
        "first_name": "MINA",
        "middle_name": "LYNN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-04-06",
        "last_updated": "2025-02-11",
        "certification_date": "2025-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "172248",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.