Healthcare Provider Details

I. General information

NPI: 1457643686
Provider Name (Legal Business Name): SIERRA WITNOV CAGLEY R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 CAMINO DEL REMEDIO PUBLIC HEALTH DEPARTMENT
SANTA BARBARA CA
93110-1332
US

IV. Provider business mailing address

300 N SAN ANTONIO RD
SANTA BARBARA CA
93110-1316
US

V. Phone/Fax

Practice location:
  • Phone: 805-681-5272
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1039825
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: