Provider Demographics
NPI:1073121760
Name:BANILOHI, SARA SHEILA (OD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:SHEILA
Last Name:BANILOHI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16311 VENTURA BLVD STE 750
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4325
Mailing Address - Country:US
Mailing Address - Phone:818-990-3623
Mailing Address - Fax:
Practice Address - Street 1:16311 VENTURA BLVD STE 750
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4325
Practice Address - Country:US
Practice Address - Phone:818-990-3623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-19
Last Update Date:2020-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34041TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist