Provider Demographics
NPI:1659853778
Name:FRIEDMAN, SANDRA (RD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 N CALIFORNIA ST STE 7
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-2130
Mailing Address - Country:US
Mailing Address - Phone:209-870-5000
Mailing Address - Fax:
Practice Address - Street 1:730 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-4104
Practice Address - Country:US
Practice Address - Phone:209-650-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered