Provider Demographics
NPI:1649950486
Name:SARA JOHANSEN, M.D., P.C.
Entity type:Organization
Organization Name:SARA JOHANSEN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-382-2191
Mailing Address - Street 1:1 BLACKFIELD DR # 152
Mailing Address - Street 2:
Mailing Address - City:TIBURON
Mailing Address - State:CA
Mailing Address - Zip Code:94920-2053
Mailing Address - Country:US
Mailing Address - Phone:650-382-2191
Mailing Address - Fax:
Practice Address - Street 1:44 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-4602
Practice Address - Country:US
Practice Address - Phone:650-382-2191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health