Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC18269 | CA |
NPI | 1205268596 |
---|---|
Provider Name | Erda Sanders |
First Address | Berkeley, CA 94705-1830 |
Second Address | Berkeley, CA 94705-1830 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2013 |
Last Update Date | 08/08/2013 |