Provider Demographics
NPI:1255797122
Name:MANN, AMANDEEP KAUR (RDN)
Entity type:Individual
Prefix:
First Name:AMANDEEP
Middle Name:KAUR
Last Name:MANN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:AMANDEEP
Other - Middle Name:KAUR
Other - Last Name:HARMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:4855 ATHERTON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95130-1026
Mailing Address - Country:US
Mailing Address - Phone:408-963-2400
Mailing Address - Fax:
Practice Address - Street 1:4855 ATHERTON AVE STE 101
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95130-1026
Practice Address - Country:US
Practice Address - Phone:408-963-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86033768133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered