Provider Demographics
NPI:1124257126
Name:TREYVE, SAMANTHA (MS, RD)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:
Last Name:TREYVE
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 2ND ST APT 313
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-7405
Mailing Address - Country:US
Mailing Address - Phone:415-640-8910
Mailing Address - Fax:
Practice Address - Street 1:2030 DIVISADERO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2113
Practice Address - Country:US
Practice Address - Phone:415-640-8910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-11
Last Update Date:2009-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00988296133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered