Provider Demographics
NPI:1144928086
Name:MINDFULLY SARA, INC.
Entity type:Organization
Organization Name:MINDFULLY SARA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN NUTRITIONIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN
Authorized Official - Phone:424-234-3128
Mailing Address - Street 1:PO BOX 50214
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91614-5021
Mailing Address - Country:US
Mailing Address - Phone:424-234-3128
Mailing Address - Fax:
Practice Address - Street 1:3950 LAUREL CANYON BLVD UNIT 50214
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91614-7014
Practice Address - Country:US
Practice Address - Phone:424-234-3128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA86152212OtherCOMMISSION ON DIETETICS REGISTRATION