Healthcare Provider Details

I. General information

NPI: 1508801572
Provider Name (Legal Business Name): MRS. SARAH B RAZO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 12/01/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3832 LA SIERRA AVE
RIVERSIDE CA
92505-3528
US

IV. Provider business mailing address

FILE #55745
LOS ANGELES CA
90074-5745
US

V. Phone/Fax

Practice location:
  • Phone: 951-637-3722
  • Fax: 951-637-3793
Mailing address:
  • Phone: 909-854-8569
  • Fax: 909-854-8558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number4028
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: