Provider Demographics
NPI:1710421532
Name:TRIVEDI, ZALAK
Entity Type:Individual
Prefix:MS
First Name:ZALAK
Middle Name:
Last Name:TRIVEDI
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 1:664 SOUTHLAND MALL DRIVE
Mailing Address - Street 2:HAYWARD WELLNESS CENTER
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-6528
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:664 SOUTHLAND MALL DRIVE
Practice Address - Street 2:HAYWARD WELLNESS CENTER
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-6528
Practice Address - Country:US
Practice Address - Phone:510-266-1771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1067790133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered