Healthcare Provider Details

I. General information

NPI: 1619832730
Provider Name (Legal Business Name): SARAH AVALOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21098 MARIGOLD ST
LEONARDTOWN MD
20650-3632
US

IV. Provider business mailing address

21098 MARIGOLD ST
LEONARDTOWN MD
20650-3632
US

V. Phone/Fax

Practice location:
  • Phone: 757-802-2836
  • Fax:
Mailing address:
  • Phone: 757-802-2836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberR223198
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: