Provider Demographics
NPI:1134400492
Name:MINA, SARAH L (DPM)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:L
Last Name:MINA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:655 HARMON LOOP RD
Mailing Address - Street 2:STE 108
Mailing Address - City:DEDEDO
Mailing Address - State:GU
Mailing Address - Zip Code:96929-6544
Mailing Address - Country:US
Mailing Address - Phone:671-633-4447
Mailing Address - Fax:
Practice Address - Street 1:600 NUT TREE RD STE 110
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-4656
Practice Address - Country:US
Practice Address - Phone:707-241-4116
Practice Address - Fax:707-241-4117
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2019-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUPOD-8213ES0103X
MI5901002396213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP41010007Medicare PIN