Provider Demographics
NPI:1164510822
Name:SAMMY, RASA B (LAC)
Entity Type:Individual
Prefix:
First Name:RASA
Middle Name:B
Last Name:SAMMY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 DREW AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-4856
Mailing Address - Country:US
Mailing Address - Phone:530-758-4474
Mailing Address - Fax:530-758-1880
Practice Address - Street 1:1460 DREW AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-4856
Practice Address - Country:US
Practice Address - Phone:530-758-4474
Practice Address - Fax:530-758-1880
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6704171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC6704OtherLIC. NUMBER