Provider Demographics
NPI:1467013722
Name:THAKUR, RIA (RD)
Entity Type:Individual
Prefix:
First Name:RIA
Middle Name:
Last Name:THAKUR
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:PO BOX 1897
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-1897
Mailing Address - Country:US
Mailing Address - Phone:707-721-3500
Mailing Address - Fax:707-721-3499
Practice Address - Street 1:1300 MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-1946
Practice Address - Country:US
Practice Address - Phone:707-721-3500
Practice Address - Fax:877-854-5151
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86107962133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty