Provider Demographics
NPI:1174618649
Name:WEAVER, SARA SANNER (MS, RD)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:SANNER
Last Name:WEAVER
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 ARAGON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2315
Mailing Address - Country:US
Mailing Address - Phone:415-515-2342
Mailing Address - Fax:
Practice Address - Street 1:111 ARAGON BLVD
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402
Practice Address - Country:US
Practice Address - Phone:415-515-2342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA805897133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered