Provider Demographics
NPI:1447252564
Name:FOLTZ, SALLY (MD)
Entity type:Individual
Prefix:DR
First Name:SALLY
Middle Name:
Last Name:FOLTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1166 ESPLANADE
Mailing Address - Street 2:STE 1
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3327
Mailing Address - Country:US
Mailing Address - Phone:530-894-0200
Mailing Address - Fax:530-894-7363
Practice Address - Street 1:1166 ESPLANADE
Practice Address - Street 2:STE 1
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3327
Practice Address - Country:US
Practice Address - Phone:530-894-0200
Practice Address - Fax:530-894-7363
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29403207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G294030Medicaid
110014274OtherMEDICARE RAILROAD #
CA00G294030Medicaid
CA00G294030Medicare ID - Type Unspecified