Provider Demographics
NPI:1326180308
Name:PARES, VIVIAN LINETTE (RDN, LDN)
Entity type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:LINETTE
Last Name:PARES
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2760 WINDING WAY
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-2759
Mailing Address - Country:US
Mailing Address - Phone:727-781-4010
Mailing Address - Fax:
Practice Address - Street 1:5225 TECH DATA DR STE 102
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3133
Practice Address - Country:US
Practice Address - Phone:727-542-3896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18300124Q00000X
FLND12610133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No124Q00000XDental ProvidersDental Hygienist