Healthcare Provider Details

I. General information

NPI: 1942175625
Provider Name (Legal Business Name): SARA ELIZABETH KOHL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2025
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 ALAMEDA DEL PRADO STE 103
NOVATO CA
94949-6698
US

IV. Provider business mailing address

2317 ORLEANS ST
SANTA ROSA CA
95403-7680
US

V. Phone/Fax

Practice location:
  • Phone: 415-457-6964
  • Fax:
Mailing address:
  • Phone: 707-495-6017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: