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General NPI Number Information
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NPI Number | 1457498958
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Entity Type | Individual
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Provider Name | MARY LYNN FARIVARI RD
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Gender | Female
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 06/01/2021
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Provider Practice Location Address
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Address Line | 2100 PENNSYLVANIA AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20037-3202
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Country | US
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Telephone | 202-872-7055
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Fax | 202-872-7132
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Provider Business Mailing Address
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Address Line | 2101 EAST JEFFERSON ST KAISER PERMANENTE 3 WEST ATTN: SANJAY MATHUR-DATA MGMT
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City | ROCVILLE
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State | MD
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Zip | 20852-4908
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Country | US
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Telephone | 301-816-7446
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Fax | 301-816-7170
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | D1100000130
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License Number State | DC
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