Provider Demographics
NPI:1558607309
Name:TRINAJSTICH, SARAH L (RD, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:L
Last Name:TRINAJSTICH
Suffix:
Gender:F
Credentials:RD, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 DEL ROSA WAY
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-2606
Mailing Address - Country:US
Mailing Address - Phone:714-330-5605
Mailing Address - Fax:
Practice Address - Street 1:1621 DEL ROSA WAY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-2606
Practice Address - Country:US
Practice Address - Phone:714-330-5605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-26
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL58272174N00000X
NV39259-DI-0133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174N00000XOther Service ProvidersLactation Consultant, Non-RN