Basic Information
| Provider Information | |||||||||
| NPI: | 1770803835 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TEIXEIRA | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 W OLYMPIC BLVD | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911991463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7759824590 | ||||||||
| FaxNumber: | 7759824595 | ||||||||
| Practice Location | |||||||||
| Address1: | 202 LOS ALTOS PKWY | ||||||||
| Address2: | |||||||||
| City: | SPARKS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894367708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7759825000 | ||||||||
| FaxNumber: | 7759826221 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2010 | ||||||||
| LastUpdateDate: | 08/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN52057 | NV | N | Nursing Service Providers | Registered Nurse | 163WX0800X | RN52057 | NV | N | Nursing Service Providers | Registered Nurse | Orthopedic | 363LF0000X | APRN001283 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 12488164 | 01 | NV | CAQH | OTHER | 1770803835 | 05 | NV | MEDICAID |