1043431224 NPI number — MS. AUDREY DAVIS OLIVER REGISTERED DIETITIAN

Table of content: MS. AUDREY DAVIS OLIVER REGISTERED DIETITIAN (NPI 1043431224)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043431224 NPI number — MS. AUDREY DAVIS OLIVER REGISTERED DIETITIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLIVER
Provider First Name:
AUDREY
Provider Middle Name:
DAVIS
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
REGISTERED DIETITIAN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OLIVER
Provider Other First Name:
AUDREY
Provider Other Middle Name:
IRENE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
REGISTERED DIETITIAN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1043431224
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
61 ALTA VISTA WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALY CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-585-0370
Provider Business Mailing Address Fax Number:
415-759-3317

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
375 LAGUNA HONDA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-759-3300
Provider Business Practice Location Address Fax Number:
415-759-3317
Provider Enumeration Date:
05/02/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  139950 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)