Provider Demographics
NPI:1225564354
Name:CARLEVATO, CATHERINE JESSICA (RD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:JESSICA
Last Name:CARLEVATO
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 1:1001 BRIDGEWAY # 644
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-2104
Mailing Address - Country:US
Mailing Address - Phone:415-755-0836
Mailing Address - Fax:
Practice Address - Street 1:1001 BRIDGEWAY # 644
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-2104
Practice Address - Country:US
Practice Address - Phone:415-755-0836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-10
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered