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NPI Code Detail

MEDICARE: MISS SARA NELSON MS

MEDICARE: MISS SARA NELSON MS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health Worker

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
126-3162747OTHERCATUTOR

General Provider Information

NPI Number : 1124381009
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS SARA NELSON MS
Provider Business Mailing Address
First Line : 2120 MONTGOMERY AVE
Second Line :
City : CARDIFF BY THE SEA
State : CA
Zip : 92007-1818
Country : US
Telephone Number : 760-525-5555
Fax Number :
Provider Business Practice Location Address
First Line : 1650 LINDA VISTA DR
Second Line : 102
City : SAN MARCOS
State : CA
Zip : 92078-3810
Country : US
Telephone Number : 760-525-5555
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2012
Last Update Date : 07/31/2012

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Directions to “ MISS SARA NELSON MS” Practice Location

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