Provider Demographics
NPI:1467505560
Name:FELIPE, GLORIA SALANAP (REGISTERED DIET TECH)
Entity Type:Individual
Prefix:MISS
First Name:GLORIA
Middle Name:SALANAP
Last Name:FELIPE
Suffix:
Gender:F
Credentials:REGISTERED DIET TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 LOS MOLINOS WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-5251
Mailing Address - Country:US
Mailing Address - Phone:831-905-9863
Mailing Address - Fax:
Practice Address - Street 1:801 LOS MOLINOS WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-5251
Practice Address - Country:US
Practice Address - Phone:831-905-9863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA726316136A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered