Provider Demographics
NPI:1629682299
Name:KALENYUK, MARINA N (RDN)
Entity Type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:N
Last Name:KALENYUK
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4930 YUCCA WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660-5647
Mailing Address - Country:US
Mailing Address - Phone:916-476-7338
Mailing Address - Fax:
Practice Address - Street 1:1400 EXPO PKWY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4230
Practice Address - Country:US
Practice Address - Phone:877-978-4848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86153019133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered