Provider Demographics
NPI:1073537460
Name:PEREZ, MARIA-ELISA TOLENTINO (RD)
Entity Type:Individual
Prefix:MRS
First Name:MARIA-ELISA
Middle Name:TOLENTINO
Last Name:PEREZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 COUNTRYWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-7744
Mailing Address - Country:US
Mailing Address - Phone:707-451-3391
Mailing Address - Fax:707-253-2851
Practice Address - Street 1:3230 BEARD RD
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3673
Practice Address - Country:US
Practice Address - Phone:707-253-7005
Practice Address - Fax:707-253-7268
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA879313133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered