MEDICARE: SUMER AL-ANI RD, LDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	DN007704	CA

General Provider Information

NPI Number	:	1417780800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUMER AL-ANI RD, LDN

Provider Business Mailing Address
First Line	:	1390 SADDLE RACK ST APT 444
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95126-5121
Country	:	US
Telephone Number	:	972-352-9972
Fax Number	:

Provider Business Practice Location Address
First Line	:	1390 SADDLE RACK ST
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95126-5112
Country	:	US
Telephone Number	:	972-352-9972
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2024
Last Update Date	:	08/22/2024

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