Provider Demographics
NPI:1750084257
Name:TELIAS RABINOVICH, ADRIANA ESTHER (RDN)
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:ESTHER
Last Name:TELIAS RABINOVICH
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 1:190 E OKEEFE ST APT 6
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-2649
Mailing Address - Country:US
Mailing Address - Phone:612-743-3840
Mailing Address - Fax:
Practice Address - Street 1:190 E OKEEFE ST APT 6
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-2649
Practice Address - Country:US
Practice Address - Phone:612-743-3840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86276784133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered