Provider Demographics
NPI:1336673169
Name:SALI, GAUTAMI (RD)
Entity Type:Individual
Prefix:
First Name:GAUTAMI
Middle Name:
Last Name:SALI
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 1:12144 FERNCREST PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4349
Mailing Address - Country:US
Mailing Address - Phone:858-248-5160
Mailing Address - Fax:
Practice Address - Street 1:12144 FERNCREST PL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-4349
Practice Address - Country:US
Practice Address - Phone:858-248-5160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered