Provider Demographics
NPI:1306328471
Name:MOSQUEDA, SARAH MICHELLE
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MICHELLE
Last Name:MOSQUEDA
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 1:2420 PACIFIC DR APT 23
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-1490
Mailing Address - Country:US
Mailing Address - Phone:408-260-2378
Mailing Address - Fax:
Practice Address - Street 1:2420 PACIFIC DR APT 23
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-1490
Practice Address - Country:US
Practice Address - Phone:408-260-2378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty