Provider Demographics
NPI:1891324646
Name:REYES, ROSALVA (RD,CDE)
Entity Type:Individual
Prefix:
First Name:ROSALVA
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:RD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N FRESNO ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93701
Mailing Address - Country:US
Mailing Address - Phone:559-459-1763
Mailing Address - Fax:559-459-1034
Practice Address - Street 1:215 N FRESNO ST
Practice Address - Street 2:SUITE 230
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701
Practice Address - Country:US
Practice Address - Phone:559-459-1763
Practice Address - Fax:559-459-1034
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA984910133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered