Provider Demographics
NPI:1275059578
Name:MATIVO, CHRISTINE NDUKU (RDN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:NDUKU
Last Name:MATIVO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 JANINE WAY APT H
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-3936
Mailing Address - Country:US
Mailing Address - Phone:559-361-2452
Mailing Address - Fax:
Practice Address - Street 1:2811 W CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-2306
Practice Address - Country:US
Practice Address - Phone:559-493-4426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered