Provider Demographics
NPI:1235738055
Name:NAOUCHI, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:NAOUCHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3451 PRAIRIE BLUFF CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-5242
Mailing Address - Country:US
Mailing Address - Phone:714-381-5432
Mailing Address - Fax:
Practice Address - Street 1:3451 PRAIRIE BLUFF CIR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80908-5242
Practice Address - Country:US
Practice Address - Phone:714-381-5432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86043172133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered