Provider Demographics
NPI:1568800159
Name:REINOSA, SARA ELISABETH
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ELISABETH
Last Name:REINOSA
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 1:111 S BARRANCA ST
Mailing Address - Street 2:APT 335
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-2220
Mailing Address - Country:US
Mailing Address - Phone:209-596-0301
Mailing Address - Fax:
Practice Address - Street 1:2500 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3464
Practice Address - Country:US
Practice Address - Phone:626-564-1613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program