Provider Demographics
NPI:1508647728
Name:ANESTIS, ADRIANA ABBOTT (RD)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:ABBOTT
Last Name:ANESTIS
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 9680
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92812-7680
Mailing Address - Country:US
Mailing Address - Phone:562-608-2492
Mailing Address - Fax:310-354-6226
Practice Address - Street 1:11591 MARGIE LN
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-2442
Practice Address - Country:US
Practice Address - Phone:714-357-7981
Practice Address - Fax:310-354-6226
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-12
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA898850133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered