Provider Demographics
NPI:1942526769
Name:MINARIK, WENDY LOUISE (RD)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:LOUISE
Last Name:MINARIK
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:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:93453-0014
Mailing Address - Country:US
Mailing Address - Phone:805-610-1151
Mailing Address - Fax:805-434-4346
Practice Address - Street 1:1100 LAS TABLAS RD
Practice Address - Street 2:DEPT OF FOOD & NUTRITION
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9704
Practice Address - Country:US
Practice Address - Phone:805-434-4546
Practice Address - Fax:805-434-4346
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR947133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered