Provider Demographics
NPI:1194522128
Name:SANFORD, KIRK (DC)
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:
Last Name:SANFORD
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4521 SAN FELIPE ST UNIT 2902
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-3388
Mailing Address - Country:US
Mailing Address - Phone:702-401-8930
Mailing Address - Fax:
Practice Address - Street 1:4521 SAN FELIPE ST UNIT 2902
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-3388
Practice Address - Country:US
Practice Address - Phone:833-564-2226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist