Provider Demographics
NPI:1609164508
Name:MORTON DE SOUZA, DONNA LYNN (RD)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:LYNN
Last Name:MORTON DE SOUZA
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 1:20 CAFARO CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1036
Mailing Address - Country:US
Mailing Address - Phone:916-601-5753
Mailing Address - Fax:
Practice Address - Street 1:20 CAFARO CIR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1036
Practice Address - Country:US
Practice Address - Phone:916-601-5753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14552133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal