Provider Demographics
NPI:1023788270
Name:FAHIMI, SARA JAZMIN
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:JAZMIN
Last Name:FAHIMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6220 OWENSMOUTH AVE APT 118
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-2249
Mailing Address - Country:US
Mailing Address - Phone:818-620-3684
Mailing Address - Fax:
Practice Address - Street 1:6220 OWENSMOUTH AVE APT 118
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2249
Practice Address - Country:US
Practice Address - Phone:818-620-3684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-19
Last Update Date:2021-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty