Provider Demographics
NPI:1538575428
Name:PAVIS, SARAH RA (MT-BC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:RA
Last Name:PAVIS
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7489 SHORELINE DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-4587
Mailing Address - Country:US
Mailing Address - Phone:805-710-6437
Mailing Address - Fax:
Practice Address - Street 1:7489 SHORELINE DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-4587
Practice Address - Country:US
Practice Address - Phone:805-710-6437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist