Provider Demographics
NPI:1427686211
Name:KODA, VEENA M (RD)
Entity type:Individual
Prefix:
First Name:VEENA
Middle Name:M
Last Name:KODA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:VEENA
Other - Middle Name:M
Other - Last Name:KODA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPH, RD
Mailing Address - Street 1:1100 SAN LEANDRO BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-1595
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 SAN LEANDRO BLVD
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-1595
Practice Address - Country:US
Practice Address - Phone:213-477-3709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-29
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR86096084133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered