Provider Demographics
NPI:1891522272
Name:OBRIEN, SARA KRISTEEN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:KRISTEEN
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 LINCOLN BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-1550
Mailing Address - Country:US
Mailing Address - Phone:608-228-2164
Mailing Address - Fax:
Practice Address - Street 1:120 S SPALDING DR STE 301
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1841
Practice Address - Country:US
Practice Address - Phone:608-228-2164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023505363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily