Provider Demographics
NPI:1437638335
Name:RAINEY, SARA KIM
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:KIM
Last Name:RAINEY
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 1:333 H ST STE 6010
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-5565
Mailing Address - Country:US
Mailing Address - Phone:619-600-1395
Mailing Address - Fax:619-344-0469
Practice Address - Street 1:333 H ST STE 6010
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5565
Practice Address - Country:US
Practice Address - Phone:619-600-1395
Practice Address - Fax:619-344-0469
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25906235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist