Provider Demographics
NPI:1578393617
Name:SAN PEDRO, GABRIELEENE VIRAY (RDN)
Entity type:Individual
Prefix:
First Name:GABRIELEENE
Middle Name:VIRAY
Last Name:SAN PEDRO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 MONTROSE RD APT N1307
Mailing Address - Street 2:
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4723
Mailing Address - Country:US
Mailing Address - Phone:917-640-7160
Mailing Address - Fax:
Practice Address - Street 1:5901 MONTROSE RD APT N1307
Practice Address - Street 2:
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-4723
Practice Address - Country:US
Practice Address - Phone:917-640-7160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86131133133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered