Healthcare Provider Details

I. General information

NPI: 1477145712
Provider Name (Legal Business Name): SARAH PRYBYLSKI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8885 RIO SAN DIEGO DR
SAN DIEGO CA
92108-1624
US

IV. Provider business mailing address

3037 INGELOW ST APT 1
SAN DIEGO CA
92106-2273
US

V. Phone/Fax

Practice location:
  • Phone: 888-743-7526
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number95085990
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: