Provider Demographics
NPI:1730266586
Name:VIVEKANANTHAN, VANATHY (RD)
Entity type:Individual
Prefix:MRS
First Name:VANATHY
Middle Name:
Last Name:VIVEKANANTHAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MRS
Other - First Name:VANANTHY
Other - Middle Name:
Other - Last Name:VIVEKANANTHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:MS#220, 1303 EAST HERNDON AVENUE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720
Mailing Address - Country:US
Mailing Address - Phone:559-450-3567
Mailing Address - Fax:
Practice Address - Street 1:MS#220 , 1303 EAST HERNDON AVENUE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720
Practice Address - Country:US
Practice Address - Phone:559-450-3567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered