Individual
MRS. JAYSHREE MUTHUKANNAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., R.D.
Contact information
Practice address
1440 168TH AVE, SAN LEANDRO, CA 94578-2409
(510) 481-6319
(510) 481-6310
Mailing address
1440 168TH AVE, SAN LEANDRO, CA 94578-2409
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
814590
CA
Other
Enumeration date
01/04/2007
Last updated
07/08/2007
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