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NPI Code Detail

MEDICARE: SARA IANNACO MA

MEDICARE:   SARA  IANNACO  MA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFC43825CA
2106H00000XMarriage & Family Therapist201871TX

General Provider Information

NPI Number : 1912139247
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARA IANNACO MA
Provider Business Mailing Address
First Line : 4511 AVENUE F
Second Line :
City : AUSTIN
State : TX
Zip : 78751-3108
Country : US
Telephone Number : 323-791-0247
Fax Number :
Provider Business Practice Location Address
First Line : 4511 AVENUE F
Second Line :
City : AUSTIN
State : TX
Zip : 78751-3108
Country : US
Telephone Number : 323-791-0247
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2009
Last Update Date : 05/22/2012

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Directions to “ SARA IANNACO MA” Practice Location

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