Provider Demographics
NPI:1790431419
Name:ANDRINGA, CARLA RENEE (RD, CD)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:RENEE
Last Name:ANDRINGA
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 JOYCE PL
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-1494
Mailing Address - Country:US
Mailing Address - Phone:509-540-5543
Mailing Address - Fax:
Practice Address - Street 1:717 FRUITVALE BLVD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-1465
Practice Address - Country:US
Practice Address - Phone:509-540-5543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00000106133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered