Provider Demographics
NPI:1184172587
Name:DEVEREAUX, MARIAN (RD)
Entity type:Individual
Prefix:MS
First Name:MARIAN
Middle Name:
Last Name:DEVEREAUX
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 1:251 OAK MANOR DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1014
Mailing Address - Country:US
Mailing Address - Phone:415-353-8814
Mailing Address - Fax:
Practice Address - Street 1:251 OAK MANOR DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:CA
Practice Address - Zip Code:94930-1014
Practice Address - Country:US
Practice Address - Phone:415-353-8814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA913448133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered