Provider Demographics
NPI:1184260986
Name:PATE, BRIAUNA LEE (RD, LD)
Entity type:Individual
Prefix:
First Name:BRIAUNA
Middle Name:LEE
Last Name:PATE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 W STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-3354
Mailing Address - Country:US
Mailing Address - Phone:559-362-3254
Mailing Address - Fax:
Practice Address - Street 1:2817 W STEWART AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-3354
Practice Address - Country:US
Practice Address - Phone:559-362-3254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164007312133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered