Provider Demographics
NPI:1053738682
Name:GOODALE, SARA ANGELA (RD, CDE)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ANGELA
Last Name:GOODALE
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:ANGELA
Other - Last Name:MALTBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CDE
Mailing Address - Street 1:1919 E. THOMAS RD.
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7710
Mailing Address - Country:US
Mailing Address - Phone:602-512-8030
Mailing Address - Fax:602-512-8161
Practice Address - Street 1:1919 E. THOMAS RD.
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7710
Practice Address - Country:US
Practice Address - Phone:602-933-0935
Practice Address - Fax:602-933-0610
Is Sole Proprietor?:No
Enumeration Date:2014-03-20
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ965214133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered