Provider Demographics
NPI:1740504281
Name:SACCOMANNO, JIM (JIM SACCOMANNO, CMT)
Entity type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:SACCOMANNO
Suffix:
Gender:M
Credentials:JIM SACCOMANNO, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 515
Mailing Address - Street 2:
Mailing Address - City:CEDAR RIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:95924-0515
Mailing Address - Country:US
Mailing Address - Phone:530-272-2630
Mailing Address - Fax:
Practice Address - Street 1:13851 SADDLE BACK RD
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945
Practice Address - Country:US
Practice Address - Phone:530-272-2630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist