Individual
SARAH C PROVENCIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
360 NE QUIMBY AVE, BEND, OR 97701-4055
(541) 382-0741
Mailing address
360 NE QUIMBY AVE, BEND, OR 97701-4055
(541) 382-0741
Taxonomy
Speciality
Code
Description
License number
State
174M00000X
Veterinarian
Primary
5796
OR
Other
Enumeration date
12/13/2010
Last updated
12/13/2010
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