Provider Demographics
NPI:1730114372
Name:APOLLO, SARAH GRAVITZ (DO)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:GRAVITZ
Last Name:APOLLO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2007
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92859-0007
Mailing Address - Country:US
Mailing Address - Phone:714-350-8934
Mailing Address - Fax:
Practice Address - Street 1:1041 E YORBA LINDA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3760
Practice Address - Country:US
Practice Address - Phone:714-350-8934
Practice Address - Fax:657-205-7517
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6613207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG36608Medicare UPIN