Healthcare Provider Details

I. General information

NPI: 1184172736
Provider Name (Legal Business Name): MARYANN CHRISTOFAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 LA CASA VIA STE 100
WALNUT CREEK CA
94598-3382
US

IV. Provider business mailing address

106 LA CASA VIA STE 100
WALNUT CREEK CA
94598-3084
US

V. Phone/Fax

Practice location:
  • Phone: 925-239-2900
  • Fax:
Mailing address:
  • Phone: 925-239-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number86006897
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: