Healthcare Provider Details

I. General information

NPI: 1942120191
Provider Name (Legal Business Name): SARA A PACKARD AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 4TH ST # 5C
SAN FRANCISCO CA
94143-2350
US

IV. Provider business mailing address

1505 JACKSON ST APT 206
OAKLAND CA
94612-4428
US

V. Phone/Fax

Practice location:
  • Phone: 409-789-5581
  • Fax:
Mailing address:
  • Phone: 409-789-5581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU4185
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: