Provider Demographics
NPI:1407208267
Name:PAVLOVA, MARIA (RD)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:
Last Name:PAVLOVA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:MASHA
Other - Middle Name:
Other - Last Name:PAVLOVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:280 GRANADA AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-2260
Mailing Address - Country:US
Mailing Address - Phone:408-768-3907
Mailing Address - Fax:
Practice Address - Street 1:1750 EL CAMINO REAL STE 202
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3214
Practice Address - Country:US
Practice Address - Phone:650-692-9751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86033693133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered