Provider Demographics
NPI:1568815041
Name:VEZIN, GWENAELLE JEANNE (RD)
Entity Type:Individual
Prefix:MRS
First Name:GWENAELLE
Middle Name:JEANNE
Last Name:VEZIN
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 1:171 JARDIN DR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1722
Mailing Address - Country:US
Mailing Address - Phone:650-935-2388
Mailing Address - Fax:
Practice Address - Street 1:171 JARDIN DR
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1722
Practice Address - Country:US
Practice Address - Phone:650-935-2388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered