Provider Demographics
NPI:1457996126
Name:KESHAVARZI, SARA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:KESHAVARZI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 S ESCONDIDO BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-6017
Mailing Address - Country:US
Mailing Address - Phone:760-566-3345
Mailing Address - Fax:
Practice Address - Street 1:1510 S ESCONDIDO BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-6017
Practice Address - Country:US
Practice Address - Phone:760-510-0055
Practice Address - Fax:760-510-0090
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-16
Last Update Date:2019-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013277363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily