Provider Demographics
NPI:1619563848
Name:BOCK, SARA KATHERINE (NP-C)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:KATHERINE
Last Name:BOCK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E. DAVIS AVENUE
Mailing Address - Street 2:
Mailing Address - City:PIXLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93256-9374
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 E. DAVIS AVE.
Practice Address - Street 2:
Practice Address - City:PIXLEY
Practice Address - State:CA
Practice Address - Zip Code:93256
Practice Address - Country:US
Practice Address - Phone:559-757-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016224363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily