Provider Demographics
NPI:1861747586
Name:FITCH, SARAH CELESTE (RD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:CELESTE
Last Name:FITCH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BODIN CIRCLE 60 MDG
Mailing Address - Street 2:
Mailing Address - City:TRAVIS AFB
Mailing Address - State:CA
Mailing Address - Zip Code:94535-1800
Mailing Address - Country:US
Mailing Address - Phone:707-423-3668
Mailing Address - Fax:707-423-2332
Practice Address - Street 1:101 BODIN CIRCLE 60 MDG
Practice Address - Street 2:
Practice Address - City:TRAVIS AFB
Practice Address - State:CA
Practice Address - Zip Code:94535-1800
Practice Address - Country:US
Practice Address - Phone:707-423-3668
Practice Address - Fax:707-423-2332
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1039714133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered