Provider Demographics
NPI:1053508382
Name:CASTALDINI, MARISA (MS RD CDE)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:CASTALDINI
Suffix:
Gender:F
Credentials:MS RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 WILLOW CREEK TER
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-1829
Mailing Address - Country:US
Mailing Address - Phone:925-240-5612
Mailing Address - Fax:925-240-0601
Practice Address - Street 1:7200 BANCROFT AVE STE 202
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2471
Practice Address - Country:US
Practice Address - Phone:408-768-3763
Practice Address - Fax:925-240-0601
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA855002133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered