Provider Demographics
NPI:1467126177
Name:ANDRADE, GINA (MPH, RD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:ANDRADE
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 NATOMAS PARK DR UNIT 6301
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-2993
Mailing Address - Country:US
Mailing Address - Phone:925-997-3033
Mailing Address - Fax:
Practice Address - Street 1:1201 ALHAMBRA BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5238
Practice Address - Country:US
Practice Address - Phone:916-774-8885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered