Healthcare Provider Details

I. General information

NPI: 1245812676
Provider Name (Legal Business Name): SARA SALEHIAZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

23329 COLONY PARK DR
CARSON CA
90745-5567
US

V. Phone/Fax

Practice location:
  • Phone: 877-925-3522
  • Fax: 203-737-5388
Mailing address:
  • Phone: 305-799-5373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number79998
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: