Provider Demographics
NPI:1659436285
Name:DELTREDICI, ANN MARIE (MS, RD)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:MARIE
Last Name:DELTREDICI
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4207 FARISS LN
Mailing Address - Street 2:
Mailing Address - City:EL SOBRANTE
Mailing Address - State:CA
Mailing Address - Zip Code:94803-2213
Mailing Address - Country:US
Mailing Address - Phone:510-222-1391
Mailing Address - Fax:
Practice Address - Street 1:929 SIR FRANCIS DRAKE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904-1548
Practice Address - Country:US
Practice Address - Phone:415-256-1301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ24022ZMedicare UPIN