Healthcare Provider Details

I. General information

NPI: 1932604923
Provider Name (Legal Business Name): SARAH L WELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 STANYAN ST # 3N
SAN FRANCISCO CA
94117-1019
US

IV. Provider business mailing address

401 UPPER TER APT 1
SAN FRANCISCO CA
94117-4547
US

V. Phone/Fax

Practice location:
  • Phone: 415-750-5580
  • Fax: 415-750-4919
Mailing address:
  • Phone: 203-952-7616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: