Provider Demographics
NPI:1073295515
Name:KAUFMAN, SARA GORMLEY (LAC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:GORMLEY
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13460 S HIGHWAY 101
Mailing Address - Street 2:
Mailing Address - City:HOPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95449-9609
Mailing Address - Country:US
Mailing Address - Phone:707-894-5313
Mailing Address - Fax:
Practice Address - Street 1:13460 S HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:HOPLAND
Practice Address - State:CA
Practice Address - Zip Code:95449-9609
Practice Address - Country:US
Practice Address - Phone:707-894-5313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16386171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist