Provider Demographics
NPI:1336754126
Name:CHOSZCZYK, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:CHOSZCZYK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 ANASAZI DR
Mailing Address - Street 2:
Mailing Address - City:AZTEC
Mailing Address - State:NM
Mailing Address - Zip Code:87410-3100
Mailing Address - Country:US
Mailing Address - Phone:970-317-5954
Mailing Address - Fax:
Practice Address - Street 1:1831 ORANGE AVE STE C
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2839
Practice Address - Country:US
Practice Address - Phone:949-574-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist