Healthcare Provider Details

I. General information

NPI: 1386397727
Provider Name (Legal Business Name): ANUSHKA P MATHUR RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 ADELINE ST
OAKLAND CA
94607-2608
US

IV. Provider business mailing address

690 MARIPOSA AVE APT 201
OAKLAND CA
94610-1310
US

V. Phone/Fax

Practice location:
  • Phone: 510-835-9610
  • Fax:
Mailing address:
  • Phone: 704-962-1259
  • Fax:

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: