Provider Demographics
NPI:1710727318
Name:COUTO, ROBERTO MANUEL-SOUSA (RDN)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:MANUEL-SOUSA
Last Name:COUTO
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 E SHAW AVE STE 139&128
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-8024
Mailing Address - Country:US
Mailing Address - Phone:559-320-0490
Mailing Address - Fax:559-320-0494
Practice Address - Street 1:1551 E SHAW AVE STE 139&128
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8024
Practice Address - Country:US
Practice Address - Phone:559-320-0490
Practice Address - Fax:559-320-0494
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered