Healthcare Provider Details

I. General information

NPI: 1386496925
Provider Name (Legal Business Name): SARAH GRACE BATARSEH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2024
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11092 ANDERSON ST
LOMA LINDA CA
92350-1706
US

IV. Provider business mailing address

14187 REFRESHING GARDEN LN
FISHERS IN
46038-5935
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12014669A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: