Provider Demographics
NPI:1730920794
Name:CHIRAYATH, REKHA F
Entity type:Individual
Prefix:
First Name:REKHA
Middle Name:F
Last Name:CHIRAYATH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11925 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7735
Mailing Address - Country:US
Mailing Address - Phone:801-545-8172
Mailing Address - Fax:801-207-8466
Practice Address - Street 1:11491 S BRAMBLEBERRY LN
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9480
Practice Address - Country:US
Practice Address - Phone:801-824-0310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT86010430133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty