Provider Demographics
NPI:1598971616
Name:FILLMORE, SARA A
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:A
Last Name:FILLMORE
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 1:10992 SAN DIEGO MISSION RD
Mailing Address - Street 2:RM 2704
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-2444
Mailing Address - Country:US
Mailing Address - Phone:619-641-2159
Mailing Address - Fax:
Practice Address - Street 1:10992 SAN DIEGO MISSION RD
Practice Address - Street 2:RM 2704
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-2444
Practice Address - Country:US
Practice Address - Phone:619-641-2159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor