Basic Information
| Provider Information | |||||||||
| NPI: | 1871895508 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONTRERAS | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | ROSE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1890 N GAREY AVE | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917672923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9096292400 | ||||||||
| FaxNumber: | 9096292448 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 N PALM CANYON DR STE 205 | ||||||||
| Address2: | |||||||||
| City: | PALM SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922624426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093234296 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2010 | ||||||||
| LastUpdateDate: | 02/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | 224535 | CA | N | Nursing Service Providers | Licensed Vocational Nurse | 363LF0000X | 95013626 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | ICAN895 | 01 | CA | LA COUNTY DMH | OTHER |