Healthcare Provider Details

I. General information

NPI: 1164303806
Provider Name (Legal Business Name): SARA GRIFFIN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8695 SPECTRUM CENTER BLVD
SAN DIEGO CA
92123-1489
US

IV. Provider business mailing address

8695 SPECTRUM CENTER BLVD
SAN DIEGO CA
92123-1489
US

V. Phone/Fax

Practice location:
  • Phone: 858-541-0181
  • Fax:
Mailing address:
  • Phone: 858-541-0181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95040700
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: