Provider Demographics
NPI:1437446341
Name:SARA, SAMREENA N (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMREENA
Middle Name:N
Last Name:SARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:24 BURNING TREE DR
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-1576
Mailing Address - Country:US
Mailing Address - Phone:509-961-3849
Mailing Address - Fax:509-426-2160
Practice Address - Street 1:7600 FERN AVE STE 700A
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5673
Practice Address - Country:US
Practice Address - Phone:318-657-0187
Practice Address - Fax:318-404-1510
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125-060625207Q00000X
LA208229207QS1201X
LAMD208229207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2337670Medicaid