Provider Demographics
NPI:1588604862
Name:MARIN, SANDRA PATRICIA (MPH, RD)
Entity Type:Individual
Prefix:MISS
First Name:SANDRA
Middle Name:PATRICIA
Last Name:MARIN
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4262 GUARDIA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-1115
Mailing Address - Country:US
Mailing Address - Phone:323-227-6326
Mailing Address - Fax:
Practice Address - Street 1:4262 GUARDIA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90032-1115
Practice Address - Country:US
Practice Address - Phone:323-227-6326
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL869673133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered