Provider Demographics
NPI:1750961702
Name:ULIVARRI, COLLETTE L (RD)
Entity type:Individual
Prefix:
First Name:COLLETTE
Middle Name:L
Last Name:ULIVARRI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7875 BLUE MOON RD
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-6346
Mailing Address - Country:US
Mailing Address - Phone:805-904-9782
Mailing Address - Fax:805-360-4050
Practice Address - Street 1:7875 BLUE MOON RD
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-6346
Practice Address - Country:US
Practice Address - Phone:805-904-9782
Practice Address - Fax:805-360-4050
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD005673133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered