Basic Information
Provider Information | |||||||||
NPI: | 1730323593 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SAWYER | ||||||||
FirstName: | CHRISTINE | ||||||||
MiddleName: | M | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | RDN, CLT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 938 DEWING AVE STE 1 | ||||||||
Address2: |   | ||||||||
City: | LAFAYETTE | ||||||||
State: | CA | ||||||||
PostalCode: | 945494271 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9253600061 | ||||||||
FaxNumber: | 9253857019 | ||||||||
Practice Location | |||||||||
Address1: | 938 DEWING AVE STE 1 | ||||||||
Address2: |   | ||||||||
City: | LAFAYETTE | ||||||||
State: | CA | ||||||||
PostalCode: | 945494271 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8175694516 | ||||||||
FaxNumber: | 8175694517 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/23/2009 | ||||||||
LastUpdateDate: | 04/22/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X |   | CA | Y |   | Dietary & Nutritional Service Providers | Dietitian, Registered |   |
No ID Information.