Provider Demographics
NPI:1770388621
Name:JAFARI, SARA (RD, LD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:JAFARI
Suffix:
Gender:
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N FAIRBANKS CT UNIT 1507
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5842
Mailing Address - Country:US
Mailing Address - Phone:240-869-3475
Mailing Address - Fax:
Practice Address - Street 1:425 CALIFORNIA ST STE 1400
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-2116
Practice Address - Country:US
Practice Address - Phone:831-484-7713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-14
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD007528133V00000X
TXDT91984133V00000X
86061924133V00000X
ZZ13074133V00000X
FLND14097133V00000X
OHLD.10926133V00000X
ORD-10253130133V00000X
IL164.011835133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty