Healthcare Provider Details

I. General information

NPI: 1790433357
Provider Name (Legal Business Name): SARAH AVIVA KONOPNICKI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27235 TOURNEY RD STE 2500
SANTA CLARITA CA
91355-5908
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 661-253-5851
  • Fax: 661-253-5852
Mailing address:
  • Phone: 310-301-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A25172
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: