Provider Demographics
NPI:1841868064
Name:VIANA, SARA J (MT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:J
Last Name:VIANA
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 E GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-2984
Mailing Address - Country:US
Mailing Address - Phone:818-660-7734
Mailing Address - Fax:
Practice Address - Street 1:1100 E BROADWAY STE 203
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-2490
Practice Address - Country:US
Practice Address - Phone:818-334-8600
Practice Address - Fax:818-824-6568
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA709683225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist