Provider Demographics
NPI:1962943217
Name:MINKOW, SARAH DOROTHY (MS, RDN)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:DOROTHY
Last Name:MINKOW
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:DOROTHY
Other - Last Name:WALATKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1443 MAIN STREET, STE 130B
Mailing Address - Street 2:NAPA
Mailing Address - City:CA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-1939
Mailing Address - Country:US
Mailing Address - Phone:707-200-1178
Mailing Address - Fax:707-847-8698
Practice Address - Street 1:116 9TH PL
Practice Address - Street 2:B
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-5661
Practice Address - Country:US
Practice Address - Phone:650-464-7895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-19
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86036712133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA86036712OtherRD NUMBER