Provider Demographics
NPI:1477054286
Name:SANSONE, KARA (MS, RD)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:SANSONE
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 REED AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-5133
Mailing Address - Country:US
Mailing Address - Phone:610-703-4488
Mailing Address - Fax:
Practice Address - Street 1:3030 CHILDREN'S WAY
Practice Address - Street 2:MEDICAL OFFICE BUILDING, 4TH FLOOR, NORTH
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:858-576-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86076428133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered