Provider Demographics
NPI:1326697863
Name:WIESTLING, SARAH ROSE
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ROSE
Last Name:WIESTLING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 AVENIDA OCEANO
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-6940
Mailing Address - Country:US
Mailing Address - Phone:760-717-3153
Mailing Address - Fax:
Practice Address - Street 1:1821 S FREEMAN ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6045
Practice Address - Country:US
Practice Address - Phone:833-747-4222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-07
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst