1770031635 NPI number — MRS. MARIA CATHERINE HETHERTON RD, CSP

Table of content: MRS. MARIA CATHERINE HETHERTON RD, CSP (NPI 1770031635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770031635 NPI number — MRS. MARIA CATHERINE HETHERTON RD, CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HETHERTON
Provider First Name:
MARIA
Provider Middle Name:
CATHERINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD, CSP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MELKO
Provider Other First Name:
MARIA
Provider Other Middle Name:
CATHERINE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD, CSP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770031635
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1855 4TH ST
Provider Second Line Business Mailing Address:
BOX 4002
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94143-2350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-502-9835
Provider Business Mailing Address Fax Number:
415-514-4359

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1855 4TH ST
Provider Second Line Business Practice Location Address:
BOX 4002
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94143-2350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-502-9835
Provider Business Practice Location Address Fax Number:
415-514-4359
Provider Enumeration Date:
09/20/2016

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: 133VN1004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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