Healthcare Provider Details

I. General information

NPI: 1174235634
Provider Name (Legal Business Name): SARA HENES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2022
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6368 HOLLYWOOD BLVD
LOS ANGELES CA
90028-6320
US

IV. Provider business mailing address

3650 BARHAM BLVD APT T211
LOS ANGELES CA
90068-1129
US

V. Phone/Fax

Practice location:
  • Phone: 323-469-5555
  • Fax:
Mailing address:
  • Phone: 661-476-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: