Healthcare Provider Details

I. General information

NPI: 1184492118
Provider Name (Legal Business Name): SARA JOSEFINA MORAN PPSC, AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2023
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1865 MONROVIA DR
SAN JOSE CA
95122-1505
US

IV. Provider business mailing address

1165 LINCOLN AVE STE 150-8493
SAN JOSE CA
95125-3043
US

V. Phone/Fax

Practice location:
  • Phone: 408-270-4992
  • Fax:
Mailing address:
  • Phone: 408-420-9526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number141712
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: