Provider Demographics
NPI:1891486148
Name:LAIRD, SARAH GILBERT
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:GILBERT
Last Name:LAIRD
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 1:1233 W SHAW AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3718
Mailing Address - Country:US
Mailing Address - Phone:559-206-7680
Mailing Address - Fax:559-206-7230
Practice Address - Street 1:1233 W SHAW AVE STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3718
Practice Address - Country:US
Practice Address - Phone:559-206-7680
Practice Address - Fax:559-206-7230
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1082243133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered