Provider Demographics
NPI:1235474396
Name:ANDARI, VILMA E (MS)
Entity Type:Individual
Prefix:
First Name:VILMA
Middle Name:E
Last Name:ANDARI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 GOLDEN EAGLE LN
Mailing Address - Street 2:
Mailing Address - City:BRISBANE
Mailing Address - State:CA
Mailing Address - Zip Code:94005-1249
Mailing Address - Country:US
Mailing Address - Phone:408-230-8928
Mailing Address - Fax:
Practice Address - Street 1:153 GOLDEN EAGLE LN
Practice Address - Street 2:
Practice Address - City:BRISBANE
Practice Address - State:CA
Practice Address - Zip Code:94005-1249
Practice Address - Country:US
Practice Address - Phone:408-230-8928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist