Provider Demographics
NPI:1043218589
Name:ROSENTHAL, SARA G (MD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:G
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 33865
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-3865
Mailing Address - Country:US
Mailing Address - Phone:619-220-4100
Mailing Address - Fax:619-270-3423
Practice Address - Street 1:2466 1ST AVE
Practice Address - Street 2:STE B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-1408
Practice Address - Country:US
Practice Address - Phone:619-230-0400
Practice Address - Fax:619-325-3688
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28150174400000X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G281500Medicaid
CAG28150OtherSTATE LICENSE
CAG28150OtherSTATE LICENSE
CAWG28150NMedicare PIN
CAG28150OtherSTATE LICENSE
CA00G281500Medicaid
CAWG28150RMedicare PIN
CAAR8107422OtherDEA CERTIFICATE
CAWG28150OMedicare PIN
CAWG28150QMedicare PIN