Provider Demographics
NPI:1023371770
Name:ALVAREZ, VANESSA (MS, RD)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9865 MAXINE ST
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-5310
Mailing Address - Country:US
Mailing Address - Phone:510-566-3294
Mailing Address - Fax:
Practice Address - Street 1:9865 MAXINE ST
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-5310
Practice Address - Country:US
Practice Address - Phone:510-566-3294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1001390133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered