Healthcare Provider Details

I. General information

NPI: 1811499718
Provider Name (Legal Business Name): SARAH BRUNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 09/23/2023
Certification Date: 09/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3978 SORRENTO VALLEY BLVD
SAN DIEGO CA
92121-1436
US

IV. Provider business mailing address

3978 SORRENTO VALLEY BLVD
SAN DIEGO CA
92121-1436
US

V. Phone/Fax

Practice location:
  • Phone: 858-951-7266
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: