Provider Demographics
NPI:1871937946
Name:FOROUHAR, SARA (MD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:FOROUHAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 E TACHEVAH DR STE 2E107
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-5752
Mailing Address - Country:US
Mailing Address - Phone:760-561-7373
Mailing Address - Fax:760-327-5140
Practice Address - Street 1:555 E TACHEVAH DR STE 2E107
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-5752
Practice Address - Country:US
Practice Address - Phone:760-561-7373
Practice Address - Fax:760-327-5140
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME127971208000000X
390200000X
CAA145453208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program