Provider Demographics
NPI:1134517543
Name:VARGAS, SARA (ATC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:VARGAS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 PACIFIC AVE
Mailing Address - Street 2:PACIFIC ATHLETIC DEPARTMENT
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95211-0110
Mailing Address - Country:US
Mailing Address - Phone:209-946-2588
Mailing Address - Fax:209-946-2190
Practice Address - Street 1:3601 PACIFIC AVE
Practice Address - Street 2:PACIFIC ATHLETIC DEPARTMENT
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95211-0110
Practice Address - Country:US
Practice Address - Phone:209-946-2588
Practice Address - Fax:209-946-2190
Is Sole Proprietor?:No
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer