Basic Information
Provider Information
NPI: 1811026859
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DREITH
FirstName: ANNETTE
MiddleName: Z.
NamePrefix:  
NameSuffix:  
Credential: RD CDE
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3400 DATA DR
Address2:  
City: RANCHO CORDOVA
State: CA
PostalCode: 956707956
CountryCode: US
TelephoneNumber: 9163792948
FaxNumber:  
Practice Location
Address1: 3000 Q ST
Address2:  
City: SACRAMENTO
State: CA
PostalCode: 958167058
CountryCode: US
TelephoneNumber: 9167333333
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/05/2007
LastUpdateDate: 08/01/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
133V00000X721676CAY Dietary & Nutritional Service ProvidersDietitian, Registered 

No ID Information.


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