Provider Demographics
NPI:1396450730
Name:PEREIRA, KRISTA MARIE (NUTRITIONIST)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:MARIE
Last Name:PEREIRA
Suffix:
Gender:F
Credentials:NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 KING RD
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-1090
Mailing Address - Country:US
Mailing Address - Phone:415-684-5573
Mailing Address - Fax:
Practice Address - Street 1:470 KING RD
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-1090
Practice Address - Country:US
Practice Address - Phone:415-684-5573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach