Provider Demographics
NPI:1609241090
Name:RAVIKUMAR, VIDYALAKSHMI
Entity Type:Individual
Prefix:MRS
First Name:VIDYALAKSHMI
Middle Name:
Last Name:RAVIKUMAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 DECATUR ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-4343
Mailing Address - Country:US
Mailing Address - Phone:202-291-4707
Mailing Address - Fax:202-723-4560
Practice Address - Street 1:1400 DECATUR ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-4343
Practice Address - Country:US
Practice Address - Phone:202-291-4707
Practice Address - Fax:202-723-4560
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDI100000775133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered