Healthcare Provider Details

I. General information

NPI: 1891486148
Provider Name (Legal Business Name): SARAH GILBERT LAIRD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 W SHAW AVE STE 103
FRESNO CA
93711-3718
US

IV. Provider business mailing address

1233 W SHAW AVE STE 103
FRESNO CA
93711-3718
US

V. Phone/Fax

Practice location:
  • Phone: 559-206-7680
  • Fax: 559-206-7230
Mailing address:
  • Phone: 559-206-7680
  • Fax: 559-206-7230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1082243
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: