Provider Demographics
NPI:1649840760
Name:VARA, SALLY (CFM)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:VARA
Suffix:
Gender:F
Credentials:CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 CIVIC CENTER DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2704
Mailing Address - Country:US
Mailing Address - Phone:530-241-4040
Mailing Address - Fax:530-241-4092
Practice Address - Street 1:2102 CIVIC CENTER DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2704
Practice Address - Country:US
Practice Address - Phone:530-241-4040
Practice Address - Fax:530-241-4091
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter