Provider Demographics
NPI:1659632305
Name:PATRIN, SARA (LAC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:PATRIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:SZMODIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:6 TRALEE CT
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-1627
Mailing Address - Country:US
Mailing Address - Phone:510-301-8107
Mailing Address - Fax:
Practice Address - Street 1:6 TRALEE CT
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-1627
Practice Address - Country:US
Practice Address - Phone:510-301-8107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14304171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist