Provider Demographics
NPI:1083356554
Name:MANZKE, KATHRYN (RDN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:MANZKE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:MANZKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDN
Mailing Address - Street 1:740 S EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-3735
Mailing Address - Country:US
Mailing Address - Phone:626-379-1082
Mailing Address - Fax:
Practice Address - Street 1:675 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-3732
Practice Address - Country:US
Practice Address - Phone:818-790-8588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133VN1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics