Provider Demographics
NPI:1699122077
Name:HENNESSY, SALLA INKERI
Entity type:Individual
Prefix:
First Name:SALLA
Middle Name:INKERI
Last Name:HENNESSY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SALLA
Other - Middle Name:INKERI
Other - Last Name:RAPAKKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 542
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95061-0542
Mailing Address - Country:US
Mailing Address - Phone:831-427-3500
Mailing Address - Fax:
Practice Address - Street 1:1510 CAPITOLA RD
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2912
Practice Address - Country:US
Practice Address - Phone:831-427-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA151448207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine