MEDICARE: SARAH GILBERT LAIRD

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	1082243	CA

General Provider Information

NPI Number	:	1891486148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH GILBERT LAIRD

Provider Business Mailing Address
First Line	:	1233 W SHAW AVE STE 103
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-3718
Country	:	US
Telephone Number	:	559-206-7680
Fax Number	:	559-206-7230

Provider Business Practice Location Address
First Line	:	1233 W SHAW AVE STE 103
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-3718
Country	:	US
Telephone Number	:	559-206-7680
Fax Number	:	559-206-7230

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

Provider Enumeration Date	:	05/17/2023
Last Update Date	:	05/17/2023

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