Provider Demographics
NPI:1851627970
Name:SOSTRIN, SARAH REBECCA (LAC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:REBECCA
Last Name:SOSTRIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5208
Mailing Address - Country:US
Mailing Address - Phone:530-477-8545
Mailing Address - Fax:
Practice Address - Street 1:1350 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5208
Practice Address - Country:US
Practice Address - Phone:530-477-8545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 11983171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist