Provider Demographics
NPI:1154664795
Name:ESCOBAR ULLOM, SARA (SARA ESCOBAR)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:ESCOBAR ULLOM
Suffix:
Gender:F
Credentials:SARA ESCOBAR
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:ULLOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SARA ULLOM
Mailing Address - Street 1:1495 DON AVE
Mailing Address - Street 2:APT. 111
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-3701
Mailing Address - Country:US
Mailing Address - Phone:949-456-3820
Mailing Address - Fax:
Practice Address - Street 1:1495 DON AVE
Practice Address - Street 2:APT. 111
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-3701
Practice Address - Country:US
Practice Address - Phone:949-456-3820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist