Provider Demographics
NPI:1174884555
Name:SANDERS, STEPHANIE LARMOUR (MSRD)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:LARMOUR
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MSRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19214 ARMINTA ST
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-1107
Mailing Address - Country:US
Mailing Address - Phone:818-398-1756
Mailing Address - Fax:818-700-5684
Practice Address - Street 1:19214 ARMINTA ST
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-1107
Practice Address - Country:US
Practice Address - Phone:818-398-1756
Practice Address - Fax:818-700-5684
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic