Healthcare Provider Details

I. General information

NPI: 1548449655
Provider Name (Legal Business Name): SARAH J SANABRIA RN, NP, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH J TAIT NP

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 08/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3883 AIRWAY DR #202
SANTA ROSA CA
95403-1670
US

IV. Provider business mailing address

3883 AIRWAY DR #202
SANTA ROSA CA
95403-1670
US

V. Phone/Fax

Practice location:
  • Phone: 707-521-8900
  • Fax: 707-523-1308
Mailing address:
  • Phone: 707-521-8900
  • Fax: 707-523-1308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number17623
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number641381
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: