Provider Demographics
NPI:1164794707
Name:SUGUMAR, REBECCA A (RD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:SUGUMAR
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 1:844 LOUISE DR
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-4138
Mailing Address - Country:US
Mailing Address - Phone:408-739-1897
Mailing Address - Fax:
Practice Address - Street 1:621 E CAMPBELL AVE
Practice Address - Street 2:SUITE # 6 B
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2139
Practice Address - Country:US
Practice Address - Phone:408-370-7731
Practice Address - Fax:408-370-7732
Is Sole Proprietor?:No
Enumeration Date:2012-01-28
Last Update Date:2012-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1051874133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered