Provider Demographics
NPI:1801494307
Name:RAMIREZ AGUAYO, SUSANA NAYELI (RD)
Entity type:Individual
Prefix:
First Name:SUSANA
Middle Name:NAYELI
Last Name:RAMIREZ AGUAYO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:NAYELI
Other - Middle Name:
Other - Last Name:RAMIREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:3950 CALLE FORTUNADA
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1827
Mailing Address - Country:US
Mailing Address - Phone:800-500-6411
Mailing Address - Fax:
Practice Address - Street 1:3950 CALLE FORTUNADA
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1827
Practice Address - Country:US
Practice Address - Phone:800-500-6411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered