Healthcare Provider Details

I. General information

NPI: 1447748751
Provider Name (Legal Business Name): SEAN AVILA SAITER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 N DUTTON AVE
SANTA ROSA CA
95401-4659
US

IV. Provider business mailing address

7420 HUNTLEY ST
SEBASTOPOL CA
95472-3658
US

V. Phone/Fax

Practice location:
  • Phone: 707-526-5424
  • Fax:
Mailing address:
  • Phone: 510-325-5205
  • 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 State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: