Provider Demographics
NPI:1194862441
Name:SACK, MARCIA E (MSRD)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:E
Last Name:SACK
Suffix:
Gender:F
Credentials:MSRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 FRESH MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-6818
Mailing Address - Country:US
Mailing Address - Phone:805-527-3559
Mailing Address - Fax:805-527-2634
Practice Address - Street 1:335 FRESH MEADOWS RD
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-6818
Practice Address - Country:US
Practice Address - Phone:805-527-3559
Practice Address - Fax:805-527-2634
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered