Provider Demographics
NPI:1124532940
Name:GONZALEZ CHAVEZ, MARIANNA YAEL (RDN)
Entity type:Individual
Prefix:
First Name:MARIANNA
Middle Name:YAEL
Last Name:GONZALEZ CHAVEZ
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:MARIANNA
Other - Middle Name:YAEL
Other - Last Name:GONZALEZ CHAVEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDN
Mailing Address - Street 1:949 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:91932-1503
Mailing Address - Country:US
Mailing Address - Phone:702-556-2180
Mailing Address - Fax:
Practice Address - Street 1:949 PALM AVE
Practice Address - Street 2:
Practice Address - City:IMPERIAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:91932-1503
Practice Address - Country:US
Practice Address - Phone:619-429-3733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-01
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86055587133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered