Provider Demographics
NPI:1962650879
Name:SARRIA, IVAN (MD)
Entity type:Individual
Prefix:DR
First Name:IVAN
Middle Name:
Last Name:SARRIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 E CARTMILL AVE
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-9610
Mailing Address - Country:US
Mailing Address - Phone:559-686-9097
Mailing Address - Fax:
Practice Address - Street 1:1134 E CARTMILL AVE
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-9610
Practice Address - Country:US
Practice Address - Phone:559-686-9097
Practice Address - Fax:559-685-4635
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2025-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD434674207V00000X
CAC55429207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021977770001Medicaid
PA1021977770001Medicaid