Provider Demographics
NPI:1700913837
Name:MATHOT, SARAH HEWITT (MS, RD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:HEWITT
Last Name:MATHOT
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 E BARKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-7003
Mailing Address - Country:US
Mailing Address - Phone:951-371-1331
Mailing Address - Fax:951-371-0331
Practice Address - Street 1:26932 OSO PKWY
Practice Address - Street 2:# 260
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5815
Practice Address - Country:US
Practice Address - Phone:949-582-8800
Practice Address - Fax:949-582-5127
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWNT952753AMedicare ID - Type Unspecified