Healthcare Provider Details

I. General information

NPI: 1437778560
Provider Name (Legal Business Name): SARAH JANE CERAMI ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 E BULLDOG LANE
FRESNO CA
93710
US

IV. Provider business mailing address

139 POLLASKY AVE APT 1
CLOVIS CA
93612-1153
US

V. Phone/Fax

Practice location:
  • Phone: 559-278-4170
  • Fax:
Mailing address:
  • Phone: 530-356-3052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000029654
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: