Healthcare Provider Details

I. General information

NPI: 1275747677
Provider Name (Legal Business Name): SARAH LANGBEIN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 GRAND AVE
OAKLAND CA
94612-3725
US

IV. Provider business mailing address

80 GRAND AVE
OAKLAND CA
94612-3725
US

V. Phone/Fax

Practice location:
  • Phone: 510-238-1200
  • Fax: 510-663-1543
Mailing address:
  • Phone: 510-238-1200
  • Fax: 510-663-1543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 19569
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.002403
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: