Provider Demographics
NPI:1629615984
Name:AFSHARPOUR, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:AFSHARPOUR
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 1:6 IMPERATRICE
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-4115
Mailing Address - Country:US
Mailing Address - Phone:949-291-6275
Mailing Address - Fax:
Practice Address - Street 1:23331 EL TORO RD STE 208
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-4883
Practice Address - Country:US
Practice Address - Phone:949-391-7790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA139443106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist