Provider Demographics
NPI:1275317695
Name:LEE, JAMIE RAE SARANGHILO (RD)
Entity Type:Individual
Prefix:
First Name:JAMIE RAE
Middle Name:SARANGHILO
Last Name:LEE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:RAE
Other - Last Name:SARANGHILO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:616 FLORENCE ST
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-2820
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:616 FLORENCE ST
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-2820
Practice Address - Country:US
Practice Address - Phone:707-334-0390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86105076133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered