Sara Harris Elisabeth Bollens, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

29438 Issued in CA

Practice address

1202 Bristol St
Costa Mesa, CA 92626-8605

Phone

(949) 267-0400

NPI assigned

Jun 20, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Sara Elisabeth Harris Former name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• UC Regents Uci Dept of Pediatrics

  • Pediatrics Physician
  • Orange, CA
  • NPI 1235187311
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1655683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704412800000",
    "number": "1356072474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 54559",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900540559",
            "telephone_number": "714-456-8068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 BRISTOL ST",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926268605",
            "telephone_number": "949-267-0400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLLENS",
        "first_name": "SARA",
        "middle_name": "HARRIS ELISABETH",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-06-20",
        "last_updated": "2024-01-05",
        "certification_date": "2024-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "29438",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SARA",
            "last_name": "HARRIS",
            "middle_name": "ELISABETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Victoria Quiroz Bojorquez
• Cruz Montana Bokolas
• Samantha Nicole Bolanos
• Peggy Bolcoa, MFT
• Lorraine Grace Bolido, RN
• Adamaris Bonilla
• Darian Bonomo
• Amy Talei Bonte, DC
• Zachary Ikaika Bonte, DC, DPT
• Matthew C Boone, MD

• Psychologist in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.