Provider Demographics
NPI:1417005588
Name:DEEPAK, SUNAINA (RD)
Entity Type:Individual
Prefix:MRS
First Name:SUNAINA
Middle Name:
Last Name:DEEPAK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:
Other - Last Name:DEEPAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:5491 SILVER SAGE CT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-5013
Mailing Address - Country:US
Mailing Address - Phone:925-672-5525
Mailing Address - Fax:
Practice Address - Street 1:2222 EAST ST
Practice Address - Street 2:SUITE 305
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2084
Practice Address - Country:US
Practice Address - Phone:925-325-0119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA857949133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ02155ZMedicare ID - Type Unspecified