Healthcare Provider Details

I. General information

NPI: 1760112072
Provider Name (Legal Business Name): MISS SARAH N SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 N EL MOLINO AVE
PASADENA CA
91101-1805
US

IV. Provider business mailing address

160 N EL MOLINO AVE
PASADENA CA
91101-1805
US

V. Phone/Fax

Practice location:
  • Phone: 626-729-2770
  • Fax:
Mailing address:
  • Phone: 626-792-2770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: