Provider Demographics
NPI:1972645067
Name:DELMAR, MISSY (RD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:MISSY
Middle Name:
Last Name:DELMAR
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 1:350 30TH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3424
Mailing Address - Country:US
Mailing Address - Phone:510-444-0790
Mailing Address - Fax:
Practice Address - Street 1:350 30TH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3424
Practice Address - Country:US
Practice Address - Phone:510-444-0790
Practice Address - Fax:510-869-6225
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA723862133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA723862OtherCDR