Provider Demographics
NPI:1821280447
Name:MATHUR, GARIMA (RD/LD, CDE)
Entity Type:Individual
Prefix:
First Name:GARIMA
Middle Name:
Last Name:MATHUR
Suffix:
Gender:F
Credentials:RD/LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-4704
Mailing Address - Country:US
Mailing Address - Phone:915-259-6946
Mailing Address - Fax:
Practice Address - Street 1:824 E 15TH ST
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-4704
Practice Address - Country:US
Practice Address - Phone:915-259-6946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06448133VN1006X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00184HMedicare PIN