Provider Demographics
NPI:1295785897
Name:CADRA, SANDRA JEAN (RD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEAN
Last Name:CADRA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:JEAN
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:350 S OAK AVE
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-3519
Mailing Address - Country:US
Mailing Address - Phone:209-848-7022
Mailing Address - Fax:209-848-7014
Practice Address - Street 1:350 S OAK AVE
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3519
Practice Address - Country:US
Practice Address - Phone:209-848-7022
Practice Address - Fax:209-848-7014
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA534372133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP71526Medicare UPIN
CAZZZ24546ZMedicare ID - Type UnspecifiedMEDICARE NUMBER