Healthcare Provider Details

I. General information

NPI: 1942065446
Provider Name (Legal Business Name): SARAH LYTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 N ST
SACRAMENTO CA
95816-5712
US

IV. Provider business mailing address

12218 ORCHID LN APT B
MORENO VALLEY CA
92557-7340
US

V. Phone/Fax

Practice location:
  • Phone: 951-719-7050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: