Healthcare Provider Details

I. General information

NPI: 1578870804
Provider Name (Legal Business Name): SHERRI FREY LUDWIG MSRD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 ADAGIO DR
FAIRFIELD CA
94534-4112
US

IV. Provider business mailing address

710 ADAGIO DR
FAIRFIELD CA
94534-4112
US

V. Phone/Fax

Practice location:
  • Phone: 707-410-6238
  • Fax: 707-207-0125
Mailing address:
  • Phone: 707-410-6238
  • Fax: 707-207-0125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number727731
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number727731
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: