Provider Demographics
NPI:1255317566
Name:MANUELITO, SARAH (RADIOLOGIC TECHNOLOG)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:
Last Name:MANUELITO
Suffix:
Gender:F
Credentials:RADIOLOGIC TECHNOLOG
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:LARGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:SHIPROCK
Mailing Address - State:NM
Mailing Address - Zip Code:87420
Mailing Address - Country:US
Mailing Address - Phone:505-368-6020
Mailing Address - Fax:505-368-6431
Practice Address - Street 1:US HWY 491 N
Practice Address - Street 2:
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420
Practice Address - Country:US
Practice Address - Phone:505-368-6020
Practice Address - Fax:505-368-6431
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
216059247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist