Provider Demographics
NPI:1073284246
Name:GRASSO, VANESSA (RD)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:GRASSO
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 1:2925 FLORENCE AVE APT 27
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-2851
Mailing Address - Country:US
Mailing Address - Phone:408-889-3768
Mailing Address - Fax:
Practice Address - Street 1:441 N CENTRAL AVE STE 2A
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-1428
Practice Address - Country:US
Practice Address - Phone:408-370-7731
Practice Address - Fax:408-370-7732
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty