Healthcare Provider Details

I. General information

NPI: 1174767461
Provider Name (Legal Business Name): SARAH KOSZYK M.A., R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2009
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 MARKET ST SUITE 1175
SAN FRANCISCO CA
94102-3099
US

IV. Provider business mailing address

870 MARKET ST SUITE 1175
SAN FRANCISCO CA
94102-3099
US

V. Phone/Fax

Practice location:
  • Phone: 415-398-2102
  • Fax: 415-398-2120
Mailing address:
  • Phone: 415-398-2102
  • Fax: 415-398-2120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number941080
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number974080
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number974080
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: