MEDICARE: SARAH JURGENS RD

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	133V00000X	Registered Dietitian	86077601	CA
2	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1740853928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH JURGENS RD

Provider Business Mailing Address
First Line	:	21721 GRANADA AVE
Second Line	:
City	:	CUPERTINO
State	:	CA
Zip	:	95014-5934
Country	:	US
Telephone Number	:	415-310-9825
Fax Number	:

Provider Business Practice Location Address
First Line	:	21721 GRANADA AVE
Second Line	:
City	:	CUPERTINO
State	:	CA
Zip	:	95014-5934
Country	:	US
Telephone Number	:	415-310-9825
Fax Number	:

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

Provider Enumeration Date	:	07/23/2021
Last Update Date	:	04/22/2026

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