Provider Demographics
NPI:1326221656
Name:MALTZMAN, SARA FRANCES (PHD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:FRANCES
Last Name:MALTZMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 RUFFIN COURT
Mailing Address - Street 2:CHILD WELFARE SERVICES AB AND JESSIE POLINSKY CHILDRENS
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-5399
Mailing Address - Country:US
Mailing Address - Phone:858-514-4727
Mailing Address - Fax:858-514-4828
Practice Address - Street 1:9400 RUFFIN COURT
Practice Address - Street 2:CHILD WELFARE SERVICES AB AND JESSIE POLINSKY CHILDRENS
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-5399
Practice Address - Country:US
Practice Address - Phone:858-514-4727
Practice Address - Fax:858-514-4828
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14873103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY148730Medicaid
CAPSY148730Medicaid