Healthcare Provider Details

I. General information

NPI: 1558286401
Provider Name (Legal Business Name): SARA MATTOX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 MCCLAREN DR
CARMICHAEL CA
95608-6119
US

IV. Provider business mailing address

7111 IDLE WAY
FAIR OAKS CA
95628-4539
US

V. Phone/Fax

Practice location:
  • Phone: 916-698-0368
  • Fax:
Mailing address:
  • Phone: 916-698-0368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: