Provider Demographics
NPI:1063929719
Name:SALDIVAR, ANGELICA GAYATRI (RDN)
Entity type:Individual
Prefix:MISS
First Name:ANGELICA
Middle Name:GAYATRI
Last Name:SALDIVAR
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 1:2423 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2551
Mailing Address - Country:US
Mailing Address - Phone:510-725-8216
Mailing Address - Fax:
Practice Address - Street 1:2423 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2551
Practice Address - Country:US
Practice Address - Phone:510-725-8216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1016855133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered