Provider Demographics
NPI:1902349764
Name:HESS, SARA (RN)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:HESS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2641 MISTY MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-6202
Mailing Address - Country:US
Mailing Address - Phone:562-544-2135
Mailing Address - Fax:
Practice Address - Street 1:2641 MISTY MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-6202
Practice Address - Country:US
Practice Address - Phone:562-544-2135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA662121133NN1002X, 163WN1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN1003XNursing Service ProvidersRegistered NurseNutrition Support
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education