Healthcare Provider Details

I. General information

NPI: 1851659346
Provider Name (Legal Business Name): SARA NIMMONS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 01/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 N H ST
LOMPOC CA
93436-3301
US

IV. Provider business mailing address

3905 STATE ST # 7-345
SANTA BARBARA CA
93105-3138
US

V. Phone/Fax

Practice location:
  • Phone: 805-737-8760
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA143324
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: