Provider Demographics
NPI:1174855423
Name:GHAMRAWI, NINA JANAN (RD)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:JANAN
Last Name:GHAMRAWI
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 1:5802 ARAPAHO DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3204
Mailing Address - Country:US
Mailing Address - Phone:408-224-6440
Mailing Address - Fax:
Practice Address - Street 1:2356 MAYWOOD AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3448
Practice Address - Country:US
Practice Address - Phone:408-768-5485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00978568133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered