Provider Demographics
NPI:1942098892
Name:LARA, SANDI (MS, RDN, CSCS)
Entity type:Individual
Prefix:
First Name:SANDI
Middle Name:
Last Name:LARA
Suffix:
Gender:F
Credentials:MS, RDN, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:889 GOLDEN HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-8125
Mailing Address - Country:US
Mailing Address - Phone:254-627-9708
Mailing Address - Fax:
Practice Address - Street 1:889 GOLDEN HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:GALT
Practice Address - State:CA
Practice Address - Zip Code:95632-8125
Practice Address - Country:US
Practice Address - Phone:254-627-9708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered