Provider Demographics
NPI:1790959666
Name:BADRTALEI, SARA (BA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:BADRTALEI
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22581 PUNTAL LANA
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-1337
Mailing Address - Country:US
Mailing Address - Phone:949-533-6422
Mailing Address - Fax:
Practice Address - Street 1:22471 ASPAN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1642
Practice Address - Country:US
Practice Address - Phone:949-458-2715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor