Provider Demographics
NPI:1790486108
Name:BAKKALY, SARA ELMSIYAH
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ELMSIYAH
Last Name:BAKKALY
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 1:3105 HALEY ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93305-2119
Mailing Address - Country:US
Mailing Address - Phone:661-493-1406
Mailing Address - Fax:
Practice Address - Street 1:2001 28TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1924
Practice Address - Country:US
Practice Address - Phone:661-868-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist