Healthcare Provider Details

I. General information

NPI: 1952801862
Provider Name (Legal Business Name): CARICA THERESA SARAZA MACARIOLA AT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2018
Last Update Date: 02/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 SOLANO AVENUE
VALLEJO CA
94590
US

IV. Provider business mailing address

260 BLUEBELL PL
VALLEJO CA
94591-8086
US

V. Phone/Fax

Practice location:
  • Phone: 707-641-1111
  • Fax:
Mailing address:
  • Phone: 707-333-8705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: