Healthcare Provider Details

I. General information

NPI: 1609830975
Provider Name (Legal Business Name): SARA L. SWENSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WEBSTER ST STE 516
SAN FRANCISCO CA
94115-2381
US

IV. Provider business mailing address

PO BOX 276950
SACRAMENTO CA
95827-6950
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-2402
  • Fax: 415-369-1292
Mailing address:
  • Phone: 415-600-2402
  • Fax: 415-369-1292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG84644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: