Provider Demographics
NPI:1841768652
Name:KUMAR, PRAVEENA (RD)
Entity Type:Individual
Prefix:
First Name:PRAVEENA
Middle Name:
Last Name:KUMAR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 CARLOTTA CIR
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2366
Mailing Address - Country:US
Mailing Address - Phone:510-685-3947
Mailing Address - Fax:
Practice Address - Street 1:641 CARLOTTA CIR
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2366
Practice Address - Country:US
Practice Address - Phone:510-685-3947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA942721133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered