Provider Demographics
NPI:1871881706
Name:DURAN, VANESSA LYNN (RD)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:LYNN
Last Name:DURAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:LYNN
Other - Last Name:LADD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:7520 ARROYO CIR
Mailing Address - Street 2:DEPARTMENT OF HEALTH EDUCATION
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-7303
Mailing Address - Country:US
Mailing Address - Phone:408-848-4619
Mailing Address - Fax:408-848-7073
Practice Address - Street 1:7520 ARROYO CIR
Practice Address - Street 2:DEPARTMENT OF HEALTH EDUCATION
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-7303
Practice Address - Country:US
Practice Address - Phone:408-848-4619
Practice Address - Fax:408-848-7073
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00944329133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered