Provider Demographics
NPI:1205380268
Name:SAKALA, PAULETT
Entity Type:Individual
Prefix:
First Name:PAULETT
Middle Name:
Last Name:SAKALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3517 W NORTHGATE DR APT 808
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-3076
Mailing Address - Country:US
Mailing Address - Phone:469-335-6791
Mailing Address - Fax:
Practice Address - Street 1:3517 W NORTHGATE DR APT 808
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-3076
Practice Address - Country:US
Practice Address - Phone:469-335-6791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02853280171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor