Provider Demographics
NPI:1730994286
Name:PUST, SARA I
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:I
Last Name:PUST
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 1:463 PETUNIA CT
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341-7745
Mailing Address - Country:US
Mailing Address - Phone:916-260-6075
Mailing Address - Fax:
Practice Address - Street 1:1620 N CARPENTER RD STE 19
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-1153
Practice Address - Country:US
Practice Address - Phone:209-988-5141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000000106S00000X
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician