Healthcare Provider Details

I. General information

NPI: 1477199131
Provider Name (Legal Business Name): SARAH ROSE EICHENBAUM RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2019
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 S STRATFORD AVE STE B
SANTA MARIA CA
93454-5908
US

IV. Provider business mailing address

1400 E. CHURCH STREET ATTENTION- MEDICAL STAFF OFFICE
SANTA MARIA CA
93454
US

V. Phone/Fax

Practice location:
  • Phone: 805-332-8446
  • Fax:
Mailing address:
  • Phone: 805-739-3954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: