Provider Demographics
NPI:1427639624
Name:ROSENBLUM, SARAH (MS, RD, CHES)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:ROSENBLUM
Suffix:
Gender:F
Credentials:MS, RD, CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:596 N 21ST ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-1749
Mailing Address - Country:US
Mailing Address - Phone:714-469-4540
Mailing Address - Fax:
Practice Address - Street 1:325 CREST DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-1606
Practice Address - Country:US
Practice Address - Phone:714-469-4540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86152992133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered