Healthcare Provider Details

I. General information

NPI: 1902349764
Provider Name (Legal Business Name): SARA HESS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2641 MISTY MOUNTAIN DR
CORONA CA
92882-6202
US

IV. Provider business mailing address

2641 MISTY MOUNTAIN DR
CORONA CA
92882-6202
US

V. Phone/Fax

Practice location:
  • Phone: 562-544-2135
  • Fax:
Mailing address:
  • Phone: 562-544-2135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number662121
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License Number662121
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: