Provider Demographics
NPI:1922571173
Name:WALTZ, SARAH ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ANN
Last Name:WALTZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 LYNN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1900
Mailing Address - Country:US
Mailing Address - Phone:805-495-1066
Mailing Address - Fax:805-497-1782
Practice Address - Street 1:2230 LYNN RD STE 200
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1900
Practice Address - Country:US
Practice Address - Phone:805-495-1066
Practice Address - Fax:805-497-1782
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2019-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-08628363A00000X
CAPA56424363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant