Healthcare Provider Details

I. General information

NPI: 1710727318
Provider Name (Legal Business Name): ROBERTO MANUEL-SOUSA COUTO RDN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 E SHAW AVE STE 139&128
FRESNO CA
93710-8024
US

IV. Provider business mailing address

1551 E SHAW AVE STE 139&128
FRESNO CA
93710-8024
US

V. Phone/Fax

Practice location:
  • Phone: 559-320-0490
  • Fax: 559-320-0494
Mailing address:
  • Phone: 559-320-0490
  • Fax: 559-320-0494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: