Provider Demographics
NPI:1508906678
Name:PANICO, LINDA C (RD, CDE)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:C
Last Name:PANICO
Suffix:
Gender:F
Credentials:RD, CDE
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 7999
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94120-7999
Mailing Address - Country:US
Mailing Address - Phone:415-600-0506
Mailing Address - Fax:415-600-6279
Practice Address - Street 1:3801 SACRAMENTO ST. 7TH FLOOR
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118
Practice Address - Country:US
Practice Address - Phone:415-600-0506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA500764133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered