Healthcare Provider Details

I. General information

NPI: 1891690178
Provider Name (Legal Business Name): PAVITHRA RAMACHANDRAN MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 EL CAJON BLVD FL 1
EL CAJON CA
92020-5714
US

IV. Provider business mailing address

12071 WORLD TRADE DR UNIT 4
SAN DIEGO CA
92128-4390
US

V. Phone/Fax

Practice location:
  • Phone: 619-662-4100
  • Fax:
Mailing address:
  • Phone: 858-335-5742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86104241
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: