Provider Demographics
NPI:1376195131
Name:MAKOWSKI, MARYAM SARAH (PHD, FACN, NBC-HWC)
Entity Type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:SARAH
Last Name:MAKOWSKI
Suffix:
Gender:F
Credentials:PHD, FACN, NBC-HWC
Other - Prefix:DR
Other - First Name:MARYAM
Other - Middle Name:SARAH
Other - Last Name:HAMIDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, FACN, NBC-HWC
Mailing Address - Street 1:300 PASTEUR DR
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-2200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-557-8901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X, 133NN1002X
CAA-3233900171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education