Healthcare Provider Details

I. General information

NPI: 1215554068
Provider Name (Legal Business Name): SARAH LOUISE STORNIOLO NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2020
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8631 W 3RD ST STE 1035
LOS ANGELES CA
90048-5964
US

IV. Provider business mailing address

4000 HOLLYWOOD BLVD STE 215S
HOLLYWOOD FL
33021-1227
US

V. Phone/Fax

Practice location:
  • Phone: 310-659-9075
  • Fax: 310-689-2422
Mailing address:
  • Phone: 310-659-9075
  • Fax: 310-689-2422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number202009555NP-PP
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95032524
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number237887
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201700591RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: