Provider Demographics
NPI:1720336704
Name:ZIDARU, ELENA CAMELIA (RD)
Entity Type:Individual
Prefix:MRS
First Name:ELENA
Middle Name:CAMELIA
Last Name:ZIDARU
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:ELENA
Other - Middle Name:CAMELIA
Other - Last Name:VIDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2100 WEBSTER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2373
Mailing Address - Country:US
Mailing Address - Phone:415-923-3155
Mailing Address - Fax:415-441-5128
Practice Address - Street 1:2100 WEBSTER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2373
Practice Address - Country:US
Practice Address - Phone:415-923-3155
Practice Address - Fax:415-441-5128
Is Sole Proprietor?:No
Enumeration Date:2012-08-22
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
REGISTRATION#1060269133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered