Healthcare Provider Details

I. General information

NPI: 1679409957
Provider Name (Legal Business Name): SARAH ELIZABETH MANCUSO RULON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 ROLLING OAKS DR STE 204
THOUSAND OAKS CA
91361-1020
US

IV. Provider business mailing address

618 NOBLE RD
SIMI VALLEY CA
93065-5339
US

V. Phone/Fax

Practice location:
  • Phone: 805-955-9493
  • Fax:
Mailing address:
  • Phone: 805-300-1505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95043892
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: