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General NPI Number Information
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NPI Number | 1154137321
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Entity Type | Organization
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Legal Business Name | SOBRAS RESTAURANT GROUP LLC
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Dates
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Enumeration Date | 12/03/2024
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 1521 SW 98TH ST UNIT D1
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City | SEATTLE
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State | WA
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Zip | 98106-2865
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Country | US
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Telephone | 206-915-8255
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Fax |
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Provider Business Mailing Address
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Address Line | 4228 249TH CT SE
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City | SAMMAMISH
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State | WA
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Zip | 98029-5792
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Country | US
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Telephone | 206-915-8255
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | EDA V MARTIN
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Credential | RDN
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Telephone | 310-308-4463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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