Provider Demographics
NPI:1417585118
Name:GRANUCCI, NATALIE KAY (RD)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:KAY
Last Name:GRANUCCI
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 1:1575 SPINNAKER DR STE 205A
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-4369
Mailing Address - Country:US
Mailing Address - Phone:805-585-7852
Mailing Address - Fax:
Practice Address - Street 1:1575 SPINNAKER DR STE 205A
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-4369
Practice Address - Country:US
Practice Address - Phone:805-585-7852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-29
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA86070883OtherCDR