Provider Demographics
NPI:1205274107
Name:MOHAM, SAMIN (RD)
Entity type:Individual
Prefix:
First Name:SAMIN
Middle Name:
Last Name:MOHAM
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 1:351 SOUTH PATTERSON AVE, PO BOX 6306
Mailing Address - Street 2:GOLETA VALLEY COTTAGE HOSPITAL--NUTRITION DEPARTMENT
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93160-6306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:351 SOUTH PATTERSON AVE
Practice Address - Street 2:GOLETA VALLEY COTTAGE HOSPITAL--NUTRITION DEPARTMENT
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93160-6306
Practice Address - Country:US
Practice Address - Phone:805-681-6441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1000242133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered