Provider Demographics
NPI:1629512793
Name:MARU, LEANNE M (RD, CSR)
Entity Type:Individual
Prefix:MRS
First Name:LEANNE
Middle Name:M
Last Name:MARU
Suffix:
Gender:F
Credentials:RD, CSR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1742 CALGARY DR
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-5219
Mailing Address - Country:US
Mailing Address - Phone:408-799-7443
Mailing Address - Fax:
Practice Address - Street 1:1742 CALGARY DR
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-5219
Practice Address - Country:US
Practice Address - Phone:408-799-7443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist