Provider Demographics
NPI:1871861419
Name:SARLES, DIANNE PATRICIA
Entity Type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:PATRICIA
Last Name:SARLES
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 1:4109 MEDOC MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-1627
Mailing Address - Country:US
Mailing Address - Phone:704-321-9791
Mailing Address - Fax:
Practice Address - Street 1:4109 MEDOC MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-1627
Practice Address - Country:US
Practice Address - Phone:704-321-9791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-11
Last Update Date:2011-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA4440174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist