Healthcare Provider Details

I. General information

NPI: 1760819387
Provider Name (Legal Business Name): SALLY ANN CARTAGENA RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 BELLE OAKS DR SUITE 280
N CHARLESTON SC
29405-8537
US

IV. Provider business mailing address

840 SPARKLEBERRY LN APT 410
COLUMBIA SC
29229-6563
US

V. Phone/Fax

Practice location:
  • Phone: 866-571-2700
  • Fax:
Mailing address:
  • Phone: 803-457-4292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number460
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: