Provider Demographics
NPI:1124381009
Name:NELSON, SARA (MS)
Entity Type:Individual
Prefix:MISS
First Name:SARA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:CARDIFF BY THE SEA
Mailing Address - State:CA
Mailing Address - Zip Code:92007-1818
Mailing Address - Country:US
Mailing Address - Phone:760-525-5555
Mailing Address - Fax:
Practice Address - Street 1:1650 LINDA VISTA DR
Practice Address - Street 2:102
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-3810
Practice Address - Country:US
Practice Address - Phone:760-525-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-16
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA26-3162747OtherTUTOR