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General NPI Number Information
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NPI Number | 1477948313
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Entity Type | Individual
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Provider Name | SARAH KALLIATH DO
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Gender | Female
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Dates
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Enumeration Date | 03/30/2015
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Last Update Date | 01/24/2023
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Provider Practice Location Address
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Address Line | 4305 LA JOLLA VILLAGE DR # 2518
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City | SAN DIEGO
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State | CA
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Zip | 92122-1270
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Country | US
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Telephone | 858-376-4544
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Fax |
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Provider Business Mailing Address
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Address Line | 4305 LA JOLLA VILLAGE DR # 2518
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City | SAN DIEGO
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State | CA
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Zip | 92122-1270
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036144409
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License Number State | IL
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