Provider Demographics
NPI:1558171363
Name:SARDINA, GARY J (RDN)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:J
Last Name:SARDINA
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27759 WAKEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CASTAIC
Mailing Address - State:CA
Mailing Address - Zip Code:91384-3520
Mailing Address - Country:US
Mailing Address - Phone:858-344-0515
Mailing Address - Fax:
Practice Address - Street 1:27759 WAKEFIELD RD
Practice Address - Street 2:
Practice Address - City:CASTAIC
Practice Address - State:CA
Practice Address - Zip Code:91384-3520
Practice Address - Country:US
Practice Address - Phone:858-344-0515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86069626133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered