Healthcare Provider Details

I. General information

NPI: 1659847762
Provider Name (Legal Business Name): SARAH FAIRLIGHT LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14880 LOS GATOS BLVD
LOS GATOS CA
95032-2011
US

IV. Provider business mailing address

379 CAMINO VERDE
BOULDER CREEK CA
95006-9151
US

V. Phone/Fax

Practice location:
  • Phone: 408-429-8110
  • Fax:
Mailing address:
  • Phone: 801-808-3297
  • Fax: 801-405-6260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM746
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number746
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-320440
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: