Provider Demographics
NPI:1912170085
Name:JEFFERSON, SARA
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3459
Mailing Address - Country:US
Mailing Address - Phone:626-308-5591
Mailing Address - Fax:626-300-8062
Practice Address - Street 1:200 W WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3459
Practice Address - Country:US
Practice Address - Phone:626-308-5591
Practice Address - Fax:626-300-8062
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator