Provider Demographics
NPI:1710690334
Name:SILVA, ODELIA ASUCENA (MSCN)
Entity Type:Individual
Prefix:
First Name:ODELIA
Middle Name:ASUCENA
Last Name:SILVA
Suffix:
Gender:F
Credentials:MSCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8255 VINEYARD AVE APT 700B
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3378
Mailing Address - Country:US
Mailing Address - Phone:530-386-5880
Mailing Address - Fax:
Practice Address - Street 1:8255 VINEYARD AVE APT 700B
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3378
Practice Address - Country:US
Practice Address - Phone:530-386-5880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist