Healthcare Provider Details

I. General information

NPI: 1275444606
Provider Name (Legal Business Name): SARA KARILINE MCEVOY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 LOS GAMOS RD APT J
SAN RAFAEL CA
94903-2537
US

IV. Provider business mailing address

1008 LOS GAMOS RD APT J
SAN RAFAEL CA
94903-2537
US

V. Phone/Fax

Practice location:
  • Phone: 415-577-5168
  • Fax:
Mailing address:
  • Phone: 415-577-5168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-QGYVSF
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: