Provider Demographics
NPI:1003905605
Name:JARA, SANDRA MARITZA (MD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:MARITZA
Last Name:JARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10034 CYPRESS SHADOW AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1858
Mailing Address - Country:US
Mailing Address - Phone:813-994-2486
Mailing Address - Fax:
Practice Address - Street 1:10034 CYPRESS SHADOW AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-1858
Practice Address - Country:US
Practice Address - Phone:813-994-2486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88282207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology