Provider Demographics
NPI:1992041685
Name:VANDIEN, VIMLAN (RD)
Entity type:Individual
Prefix:
First Name:VIMLAN
Middle Name:
Last Name:VANDIEN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2261 ELM ST
Mailing Address - Street 2:BUILDING G
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-3721
Mailing Address - Country:US
Mailing Address - Phone:707-253-4272
Mailing Address - Fax:
Practice Address - Street 1:2344 OLD SONOMA RD
Practice Address - Street 2:BUILDING G
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-3708
Practice Address - Country:US
Practice Address - Phone:707-253-4272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA858852133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered