Provider Demographics
NPI:1497366280
Name:MONTAZERIPOUR, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:MONTAZERIPOUR
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 1:22100 BURBANK BLVD UNIT 259G
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6251
Mailing Address - Country:US
Mailing Address - Phone:949-527-8111
Mailing Address - Fax:
Practice Address - Street 1:22100 BURBANK BLVD UNIT 259G
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6251
Practice Address - Country:US
Practice Address - Phone:949-527-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86041894133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered