Healthcare Provider Details

I. General information

NPI: 1538087317
Provider Name (Legal Business Name): SARAH IRENE MIELKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10710 N TORREY PINES RD
LA JOLLA CA
92037-1035
US

IV. Provider business mailing address

7104 BELDEN ST
SAN DIEGO CA
92111-4231
US

V. Phone/Fax

Practice location:
  • Phone: 858-554-8638
  • Fax:
Mailing address:
  • Phone: 858-554-8638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number774648
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: