Healthcare Provider Details

I. General information

NPI: 1710899398
Provider Name (Legal Business Name): SARAH DOUGLASS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 MEDICAL CENTER CT
CHULA VISTA CA
91911-6618
US

IV. Provider business mailing address

1535 FELSPAR ST APT 8
SAN DIEGO CA
92109-3010
US

V. Phone/Fax

Practice location:
  • Phone: 858-463-0606
  • Fax:
Mailing address:
  • Phone: 480-365-8764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: