Healthcare Provider Details

I. General information

NPI: 1194647289
Provider Name (Legal Business Name): SARA ORNELAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 N 5TH ST
PHOENIX AZ
85004-2157
US

IV. Provider business mailing address

7359 W PEPPERTREE LN
GLENDALE AZ
85303-3027
US

V. Phone/Fax

Practice location:
  • Phone: 602-827-2002
  • Fax:
Mailing address:
  • Phone: 623-806-3481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: