Healthcare Provider Details

I. General information

NPI: 1013169622
Provider Name (Legal Business Name): SARA JEAN DEMERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 CUSHING RD
SAN DIEGO CA
92106-6173
US

IV. Provider business mailing address

2051 CUSHING RD
SAN DIEGO CA
92106-6173
US

V. Phone/Fax

Practice location:
  • Phone: 619-524-5204
  • Fax:
Mailing address:
  • Phone: 619-524-5204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: