Healthcare Provider Details

I. General information

NPI: 1801161054
Provider Name (Legal Business Name): SARA GOLFEIZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23861 W MCBEAN PKWY STE A4
VALENCIA CA
91355-2003
US

IV. Provider business mailing address

PO BOX 261098
ENCINO CA
91426-1098
US

V. Phone/Fax

Practice location:
  • Phone: 661-288-7978
  • Fax:
Mailing address:
  • Phone: 818-426-1136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA22166
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: