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General NPI Number Information
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NPI Number | 1386463107
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Entity Type | Individual
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Provider Name | SARA BEARDSHEAR FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/08/2024
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 5555 GROSSMONT CENTER DR
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City | LA MESA
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State | CA
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Zip | 91942-3019
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Country | US
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Telephone | 619-740-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 8030 LA MESA BLVD # 596
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City | LA MESA
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State | CA
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Zip | 91942-0335
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95031154
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License Number State | CA
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