MEDICARE: SARAH ROSENBLUM MS, RD, CHES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	86152992	CA

General Provider Information

NPI Number	:	1427639624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH ROSENBLUM MS, RD, CHES

Provider Business Mailing Address
First Line	:	596 N 21ST ST
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95112-1749
Country	:	US
Telephone Number	:	714-469-4540
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 CREST DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95127-1606
Country	:	US
Telephone Number	:	714-469-4540
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2021
Last Update Date	:	04/19/2021

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