Healthcare Provider Details

I. General information

NPI: 1790359883
Provider Name (Legal Business Name): SARA G COHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA H GRILL

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 BROADWAY
OAKLAND CA
94611-5730
US

IV. Provider business mailing address

4633 DAVENPORT AVE
OAKLAND CA
94619-2916
US

V. Phone/Fax

Practice location:
  • Phone: 510-752-7234
  • Fax:
Mailing address:
  • Phone: 650-430-0957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number4751
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: