Healthcare Provider Details

I. General information

NPI: 1588904809
Provider Name (Legal Business Name): ELENA MARIE CAVIAR MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2013
Last Update Date: 02/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 MOORPARK AVE
SAN JOSE CA
95128-2613
US

IV. Provider business mailing address

853 N 5TH ST
SAN JOSE CA
95112-5021
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-5823
  • Fax:
Mailing address:
  • Phone: 408-667-0353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number894198
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number894198
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: