Healthcare Provider Details

I. General information

NPI: 1295148492
Provider Name (Legal Business Name): SARAH VAN CAMP DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH DONNELLY DO

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 BISHOP ST
SAN LUIS OBISPO CA
93401-4635
US

IV. Provider business mailing address

2050 S BLOSSER RD
SANTA MARIA CA
93458-7310
US

V. Phone/Fax

Practice location:
  • Phone: 805-238-7250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36673
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17839
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: