Provider Demographics
NPI:1467735183
Name:STANFORD, ANGELA (RD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:STANFORD
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 1:9000 CROW CANYON RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-1189
Mailing Address - Country:US
Mailing Address - Phone:925-389-7107
Mailing Address - Fax:925-736-1009
Practice Address - Street 1:9000 CROW CANYON RD
Practice Address - Street 2:SUITE 320
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-1189
Practice Address - Country:US
Practice Address - Phone:925-389-7107
Practice Address - Fax:925-736-1009
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA807339133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered