Provider Demographics
NPI:1043541584
Name:CHETRIT, DAKOTA WREN (PA-C, RD)
Entity type:Individual
Prefix:
First Name:DAKOTA
Middle Name:WREN
Last Name:CHETRIT
Suffix:
Gender:F
Credentials:PA-C, RD
Other - Prefix:
Other - First Name:DAKOTA
Other - Middle Name:
Other - Last Name:ALLSTADT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3913 BOYLE CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2922
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:565 S KOMAS DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1208
Practice Address - Country:US
Practice Address - Phone:801-584-5144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1036816133V00000X
UT8668423-1206207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered