Healthcare Provider Details

I. General information

NPI: 1225681232
Provider Name (Legal Business Name): SARAH MARIA MENCIA FERNANDEZ MAS, RD, CSP, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 4TH ST
SAN FRANCISCO CA
94143-2350
US

IV. Provider business mailing address

1855 4TH ST
SAN FRANCISCO CA
94143-2350
US

V. Phone/Fax

Practice location:
  • Phone: 415-514-8818
  • Fax:
Mailing address:
  • Phone: 415-514-8818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number86049011
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-110986
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT91940
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: