Healthcare Provider Details

I. General information

NPI: 1629835178
Provider Name (Legal Business Name): SARA ABDELHADI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 E COLORADO BLVD STE 180&2ND
PASADENA CA
91101-6143
US

IV. Provider business mailing address

1650 PARK NEWPORT APT 217
NEWPORT BEACH CA
92660-5038
US

V. Phone/Fax

Practice location:
  • Phone: 646-453-6777
  • Fax:
Mailing address:
  • Phone: 424-402-6781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15572
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: