1912087917 NPI number — MRS. SARAH ANN CARLBLOM MAPC, LAC

Table of content: MRS. SARAH ANN CARLBLOM MAPC, LAC (NPI 1912087917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912087917 NPI number — MRS. SARAH ANN CARLBLOM MAPC, LAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARLBLOM
Provider First Name:
SARAH
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MAPC, LAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912087917
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3603 N 7TH AVE
Provider Second Line Business Mailing Address:
CHRISTIAN FAMILY CARE AGENCY
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85013-3638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-234-1935
Provider Business Mailing Address Fax Number:
602-234-0022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3603 N 7TH AVE
Provider Second Line Business Practice Location Address:
CHRISTIAN FAMILY CARE AGENCY
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85013-3638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-234-1935
Provider Business Practice Location Address Fax Number:
602-234-0022
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LAC-12173 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com