Provider Demographics
NPI:1922318609
Name:ODOM, SARAH ANN (RD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ANN
Last Name:ODOM
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1999 MOWRY AVE
Mailing Address - Street 2:STE R
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1738
Mailing Address - Country:US
Mailing Address - Phone:510-745-8187
Mailing Address - Fax:510-795-8008
Practice Address - Street 1:1999 MOWRY AVE
Practice Address - Street 2:STE R
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1738
Practice Address - Country:US
Practice Address - Phone:510-745-8187
Practice Address - Fax:510-795-8008
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered