Provider Demographics
NPI:1114248200
Name:JAYAGOPAL, AMRITA (RD, MA, CDE)
Entity Type:Individual
Prefix:
First Name:AMRITA
Middle Name:
Last Name:JAYAGOPAL
Suffix:
Gender:F
Credentials:RD, MA, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2383 N MAIN ST
Mailing Address - Street 2:UNIT 222
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-3549
Mailing Address - Country:US
Mailing Address - Phone:925-954-7213
Mailing Address - Fax:
Practice Address - Street 1:168 11TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4841
Practice Address - Country:US
Practice Address - Phone:510-419-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-12
Last Update Date:2010-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered