Provider Demographics
NPI:1578830121
Name:BADRI, REVA BIRNBAUM (MS, RD)
Entity Type:Individual
Prefix:MRS
First Name:REVA
Middle Name:BIRNBAUM
Last Name:BADRI
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:MS
Other - First Name:REVA
Other - Middle Name:BUCKHORN
Other - Last Name:BIRNBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:546 27TH AVE
Mailing Address - Street 2:#1
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-2859
Mailing Address - Country:US
Mailing Address - Phone:415-328-5134
Mailing Address - Fax:
Practice Address - Street 1:546 27TH AVE
Practice Address - Street 2:#1
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-2859
Practice Address - Country:US
Practice Address - Phone:415-328-5134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1104952133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered