Healthcare Provider Details

I. General information

NPI: 1467017772
Provider Name (Legal Business Name): SAGHAR SEFIDBAKHT RD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26730 TOWNE CENTRE DR STE 102
FOOTHILL RANCH CA
92610-2857
US

IV. Provider business mailing address

26730 TOWNE CENTRE DR STE 102
FOOTHILL RANCH CA
92610-2857
US

V. Phone/Fax

Practice location:
  • Phone: 800-954-8000
  • Fax:
Mailing address:
  • Phone: 949-259-0787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: