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General NPI Number Information
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NPI Number | 1144816745
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Entity Type | Organization
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Legal Business Name | SAKURA WELLNESS & PSYCHOLOGICAL SERVICES INC
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Dates
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Enumeration Date | 12/17/2020
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Last Update Date | 02/03/2022
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Provider Practice Location Address
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Address Line | 440 STEVENS AVE STE 200
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City | SOLANA BEACH
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State | CA
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Zip | 92075-2059
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Country | US
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Telephone | 443-534-4268
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Fax |
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Provider Business Mailing Address
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Address Line | 440 STEVENS AVE STE 200
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City | SOLANA BEACH
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State | CA
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Zip | 92075-2059
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Country | US
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Telephone | 443-534-4268
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SARAH GRUSZKA
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Credential | PSYD
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Telephone | 443-534-4268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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