Healthcare Provider Details

I. General information

NPI: 1265783039
Provider Name (Legal Business Name): SARA REGINA KREIMER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2012
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST
LOS ANGELES CA
90033-1029
US

IV. Provider business mailing address

20695 KELFIELD DR
WALNUT CA
91789-3842
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-6931
  • Fax:
Mailing address:
  • Phone: 951-236-7497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA122929
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberA122929
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: