Provider Demographics
NPI:1245697135
Name:VARGAS, SARA DINOME TEEL (DC)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:DINOME TEEL
Last Name:VARGAS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:DINOME
Other - Last Name:TEEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3286 ADELINE ST.
Mailing Address - Street 2:SUITE 9
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703
Mailing Address - Country:US
Mailing Address - Phone:510-428-2332
Mailing Address - Fax:
Practice Address - Street 1:3286 ADELINE ST.
Practice Address - Street 2:SUITE 9
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703
Practice Address - Country:US
Practice Address - Phone:510-428-2332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32060111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor