Healthcare Provider Details

I. General information

NPI: 1265625792
Provider Name (Legal Business Name): ELIZABETH LOPEZ SARABIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 SAN FELIPE RD
HOLLISTER CA
95023-2800
US

IV. Provider business mailing address

1215 SAN BENITO ST
HOLLISTER CA
95023-4843
US

V. Phone/Fax

Practice location:
  • Phone: 831-636-4020
  • Fax:
Mailing address:
  • Phone: 805-729-6428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number79418
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: