Healthcare Provider Details

I. General information

NPI: 1770937096
Provider Name (Legal Business Name): SARA ABOLMAALI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15457 SPECTRUM
IRVINE CA
92618-3423
US

IV. Provider business mailing address

26630 BARTON RD APT 2915
REDLANDS CA
92373-4332
US

V. Phone/Fax

Practice location:
  • Phone: 619-925-2572
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number100135
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: