Provider Demographics
NPI:1154188571
Name:GHIRMATSION, SARA M (NURSEAIDE)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:M
Last Name:GHIRMATSION
Suffix:
Gender:F
Credentials:NURSEAIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:697 39TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-2374
Mailing Address - Country:US
Mailing Address - Phone:510-588-0704
Mailing Address - Fax:
Practice Address - Street 1:697 39TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-2374
Practice Address - Country:US
Practice Address - Phone:510-588-0704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
01280005376K00000X
CA01280005376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide