Provider Demographics
NPI:1679715957
Name:HUMBERT, SARAH ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH
Last Name:HUMBERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11201 BENTON ST
Mailing Address - Street 2:MAIL CODE 117
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-1000
Mailing Address - Country:US
Mailing Address - Phone:909-583-6369
Mailing Address - Fax:909-422-3106
Practice Address - Street 1:11201 BENTON ST
Practice Address - Street 2:MAIL CODE 117
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-1000
Practice Address - Country:US
Practice Address - Phone:909-583-6369
Practice Address - Fax:909-422-3106
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA113762208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation