Basic Information
| Provider Information | |||||||||
| NPI: | 1457498958 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARIVARI | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 EAST JEFFERSON ST | ||||||||
| Address2: | KAISER PERMANENTE 3 WEST ATTN: SANJAY MATHUR-DATA MGMT | ||||||||
| City: | ROCVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208524908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018167446 | ||||||||
| FaxNumber: | 3018167170 | ||||||||
| Practice Location | |||||||||
| Address1: | 2100 PENNSYLVANIA AVE NW | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200373202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028727055 | ||||||||
| FaxNumber: | 2028727132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2007 | ||||||||
| LastUpdateDate: | 06/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | D1100000130 | DC | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | 725254 | 01 | RD ID NUMBER | OTHER |