Provider Demographics
NPI:1477383610
Name:VAKHARIA, SARAH (MED, EDS, LEP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:VAKHARIA
Suffix:
Gender:F
Credentials:MED, EDS, LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15771 WAINWRIGHT WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-5113
Mailing Address - Country:US
Mailing Address - Phone:408-800-2564
Mailing Address - Fax:
Practice Address - Street 1:5405 MOREHOUSE DR STE 230
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4769
Practice Address - Country:US
Practice Address - Phone:408-800-2564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3779103TS0200X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool