Provider Demographics
NPI:1245545201
Name:MANETTI, STEFANIA (RD, CDE)
Entity type:Individual
Prefix:MS
First Name:STEFANIA
Middle Name:
Last Name:MANETTI
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 1:260 INTERNATIONAL CIRCLE
Mailing Address - Street 2:KAISER PERMANENTE, HEALTHY LIVING CENTER, BLDG 1 NORTH
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:260 INTERNATIONAL CIRCLE
Practice Address - Street 2:KAISER PERMANENTE, HEALTHY LIVING CENTER, BLDG 1 NORTH
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119
Practice Address - Country:US
Practice Address - Phone:408-972-6248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
996626OtherRD
21310248OtherCDE