Provider Demographics
NPI:1093949802
Name:BENDER, VILAYVANH (RD)
Entity Type:Individual
Prefix:MRS
First Name:VILAYVANH
Middle Name:
Last Name:BENDER
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 1:13370 GOLDENHORN DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-6653
Mailing Address - Country:US
Mailing Address - Phone:951-255-7090
Mailing Address - Fax:951-674-1354
Practice Address - Street 1:13370 GOLDENHORN DR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-6653
Practice Address - Country:US
Practice Address - Phone:951-255-7090
Practice Address - Fax:951-674-1354
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA819769133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered