Healthcare Provider Details

I. General information

NPI: 1891522272
Provider Name (Legal Business Name): SARA KRISTEEN OBRIEN NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S SPALDING DR STE 301
BEVERLY HILLS CA
90212-1841
US

IV. Provider business mailing address

804 LINCOLN BLVD STE 206
SANTA MONICA CA
90403-1550
US

V. Phone/Fax

Practice location:
  • Phone: 608-228-2164
  • Fax:
Mailing address:
  • Phone: 608-228-2164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95023505
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: