Provider Demographics
NPI:1336389113
Name:CORDER, SARA M (RD, MPH)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:M
Last Name:CORDER
Suffix:
Gender:F
Credentials:RD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11450 CHURCH ST APT 24
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3979
Mailing Address - Country:US
Mailing Address - Phone:909-484-1849
Mailing Address - Fax:
Practice Address - Street 1:11450 CHURCH ST APT 24
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3979
Practice Address - Country:US
Practice Address - Phone:909-484-1849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA890259133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered