Provider Demographics
NPI:1790103034
Name:PERITORE, MARIANNE (RD, CNSC)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:PERITORE
Suffix:
Gender:F
Credentials:RD, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6980 OAK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-2742
Mailing Address - Country:US
Mailing Address - Phone:831-462-5954
Mailing Address - Fax:
Practice Address - Street 1:6980 OAK RIDGE RD
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-2742
Practice Address - Country:US
Practice Address - Phone:831-462-5954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
576148133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered