Provider Demographics
NPI:1902448863
Name:STAMPS, SARA A
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:A
Last Name:STAMPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 GREY WOLF DR
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-1013
Mailing Address - Country:US
Mailing Address - Phone:707-338-8918
Mailing Address - Fax:
Practice Address - Street 1:212 GREY WOLF DR
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-1013
Practice Address - Country:US
Practice Address - Phone:707-338-8918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other