Provider Demographics
NPI:1740761535
Name:TOMINELLO, SARAH (NP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:TOMINELLO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 S FIGUEROA ST STE 810
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-5813
Mailing Address - Country:US
Mailing Address - Phone:510-926-6677
Mailing Address - Fax:
Practice Address - Street 1:777 S FIGUEROA ST STE 810
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-5813
Practice Address - Country:US
Practice Address - Phone:510-926-6677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2023-01-13
Deactivation Date:2019-07-07
Deactivation Code:
Reactivation Date:2019-09-25
Provider Licenses
StateLicense IDTaxonomies
CA95143080163WP0808X
CA95012100363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health