Provider Demographics
NPI:1033454426
Name:LAVARIAS, SARI BIANCA (PA-C)
Entity Type:Individual
Prefix:
First Name:SARI
Middle Name:BIANCA
Last Name:LAVARIAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 E MONTVUE DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6318
Mailing Address - Country:US
Mailing Address - Phone:208-855-2900
Mailing Address - Fax:208-898-9877
Practice Address - Street 1:360 E MONTVUE DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6318
Practice Address - Country:US
Practice Address - Phone:208-855-2900
Practice Address - Fax:208-898-9877
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-1035363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant