MEDICARE: SARAH DEPOL MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	25733	CA

General Provider Information

NPI Number	:	1659869790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH DEPOL MS

Provider Business Mailing Address
First Line	:	411 CAMINO DEL RIO S STE 101
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3508
Country	:	US
Telephone Number	:	619-574-8181
Fax Number	:	619-574-0802

Provider Business Practice Location Address
First Line	:	411 CAMINO DEL RIO S STE 101
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3508
Country	:	US
Telephone Number	:	619-574-8181
Fax Number	:	619-574-0802

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2018
Last Update Date	:	04/24/2018

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Directions to “ SARAH DEPOL MS” Practice Location

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