Provider Demographics
NPI:1760115844
Name:ALVIDERA, SARAH JANE PINGOL
Entity Type:Individual
Prefix:
First Name:SARAH JANE
Middle Name:PINGOL
Last Name:ALVIDERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:PINGOL-ALVIDERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 CALLE DEL RIO
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-2875
Mailing Address - Country:US
Mailing Address - Phone:949-459-7393
Mailing Address - Fax:
Practice Address - Street 1:15 CALLE DEL RIO
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2875
Practice Address - Country:US
Practice Address - Phone:949-338-2817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70381183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist