Provider Demographics
NPI:1043760333
Name:GARRETSON, SARA MARIKO (RD LD CDCES)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:MARIKO
Last Name:GARRETSON
Suffix:
Gender:F
Credentials:RD LD CDCES
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:MARIKO
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:91-039 POPOI PL
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-2934
Mailing Address - Country:US
Mailing Address - Phone:808-636-5630
Mailing Address - Fax:
Practice Address - Street 1:91-039 POPOI PL
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-2934
Practice Address - Country:US
Practice Address - Phone:808-636-5630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI127-LD133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered