Healthcare Provider Details

I. General information

NPI: 1053952754
Provider Name (Legal Business Name): SARA HUMPHREYS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2019
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29516 KOHOUTEK WAY
UNION CITY CA
94587-1221
US

IV. Provider business mailing address

1189 CAVANAUGH WAY
SACRAMENTO CA
95822-1117
US

V. Phone/Fax

Practice location:
  • Phone: 510-441-8240
  • Fax:
Mailing address:
  • Phone: 916-501-2171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number5650
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: