Provider Demographics
NPI:1649643966
Name:FERNANDEZ, MAIYU ALLANA (RDN)
Entity type:Individual
Prefix:MISS
First Name:MAIYU
Middle Name:ALLANA
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 LEE ST APT 210
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-4346
Mailing Address - Country:US
Mailing Address - Phone:202-725-8742
Mailing Address - Fax:
Practice Address - Street 1:306 LEE ST APT 210
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-4346
Practice Address - Country:US
Practice Address - Phone:202-725-8742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4833133V00000X
DCDI100000981133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered