Provider Demographics
NPI:1417103383
Name:HERON, SARA BLYTHE (MD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:BLYTHE
Last Name:HERON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 SARATOGA AVE STE 14
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-3427
Mailing Address - Country:US
Mailing Address - Phone:408-996-7950
Mailing Address - Fax:
Practice Address - Street 1:1175 SARATOGA AVE STE 14
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-3427
Practice Address - Country:US
Practice Address - Phone:408-996-7950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1122362084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry