Provider Demographics
NPI:1285841650
Name:CERNOHOUS, SARICA (LAC)
Entity Type:Individual
Prefix:
First Name:SARICA
Middle Name:
Last Name:CERNOHOUS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:SARICA
Other - Middle Name:
Other - Last Name:KLEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:606 E PHOENIX ST
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-5684
Mailing Address - Country:US
Mailing Address - Phone:928-478-8103
Mailing Address - Fax:
Practice Address - Street 1:606 E PHOENIX ST
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5684
Practice Address - Country:US
Practice Address - Phone:928-478-8103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8086171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist