Provider Demographics
NPI:1912766692
Name:SANDELL, CARA
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:SANDELL
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 1:29252 VIA FRONTERA
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-6069
Mailing Address - Country:US
Mailing Address - Phone:323-839-4809
Mailing Address - Fax:
Practice Address - Street 1:29252 VIA FRONTERA
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-6069
Practice Address - Country:US
Practice Address - Phone:323-839-4809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist