Provider Demographics
NPI:1336412808
Name:STAR, SANDI J (CNC)
Entity Type:Individual
Prefix:
First Name:SANDI
Middle Name:J
Last Name:STAR
Suffix:
Gender:F
Credentials:CNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 EL CAMINO REAL STE B
Mailing Address - Street 2:190
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1205
Mailing Address - Country:US
Mailing Address - Phone:760-685-3154
Mailing Address - Fax:760-652-1644
Practice Address - Street 1:4489 GLADSTONE CT
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92010-2872
Practice Address - Country:US
Practice Address - Phone:760-685-3154
Practice Address - Fax:760-652-1644
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACERTIFICATE133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist