Provider Demographics
NPI:1134270614
Name:RAUCH, SALLY A (RD)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:A
Last Name:RAUCH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:DOOLAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:450 E HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3748
Mailing Address - Country:US
Mailing Address - Phone:626-254-2183
Mailing Address - Fax:
Practice Address - Street 1:450 E HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3748
Practice Address - Country:US
Practice Address - Phone:626-254-2183
Practice Address - Fax:626-254-2183
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA307402133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA307402OtherDIETETIC REGISTRATION