Provider Demographics
NPI:1316727100
Name:GAINES, JANELLE NYKEBA (RDN)
Entity type:Individual
Prefix:MISS
First Name:JANELLE
Middle Name:NYKEBA
Last Name:GAINES
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 1:2041 ROBIN DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-2332
Mailing Address - Country:US
Mailing Address - Phone:707-290-1066
Mailing Address - Fax:
Practice Address - Street 1:2241 GEARY BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3415
Practice Address - Country:US
Practice Address - Phone:415-833-4877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86297856133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered