Provider Demographics
NPI:1225437262
Name:LACKNER, SARA (MD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:LACKNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:LACKNER-FOA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4451 MERLIN WAY
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2340
Mailing Address - Country:US
Mailing Address - Phone:831-462-6206
Mailing Address - Fax:
Practice Address - Street 1:4451 MERLIN WAY
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2340
Practice Address - Country:US
Practice Address - Phone:831-462-6206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52875207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine