Provider Demographics
NPI:1629319371
Name:ODONO, MARIA RODELITA DEYPALAN (RD)
Entity Type:Individual
Prefix:
First Name:MARIA RODELITA
Middle Name:DEYPALAN
Last Name:ODONO
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 1:330 N CHAPEL AVE
Mailing Address - Street 2:#103
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-2582
Mailing Address - Country:US
Mailing Address - Phone:626-416-8895
Mailing Address - Fax:
Practice Address - Street 1:330 N CHAPEL AVE
Practice Address - Street 2:#103
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-2582
Practice Address - Country:US
Practice Address - Phone:626-416-8895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1060567133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered