=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548668718
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANDRA YVONNE MURAN PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2014
-----------------------------------------------------
Last Update Date | 12/19/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1024 BAYSIDE DR # 212
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92660-7462
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-338-1274
-----------------------------------------------------
Fax | 805-548-0988
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1024 BAYSIDE DR # 212
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92660-7462
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-338-1274
-----------------------------------------------------
Fax | 805-548-0988
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133N00000X
-----------------------------------------------------
Taxonomy Name | Nutritionist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------