Healthcare Provider Details

I. General information

NPI: 1477383610
Provider Name (Legal Business Name): SARAH VAKHARIA M.ED., ED.S., LEP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 08/02/2024
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5405 MOREHOUSE DR STE 230
SAN DIEGO CA
92121-4769
US

IV. Provider business mailing address

15771 WAINWRIGHT WAY
SAN DIEGO CA
92127-5113
US

V. Phone/Fax

Practice location:
  • Phone: 408-800-2564
  • Fax:
Mailing address:
  • Phone: 408-800-2564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number3779
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3779
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: