MEDICARE: EAT 2 PERFORM INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1013399724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAT 2 PERFORM INC.

Provider Business Mailing Address
First Line	:	4546 EL CAMINO REAL
Second Line	:	#254
City	:	LOS ALTOS
State	:	CA
Zip	:	94022-1099
Country	:	US
Telephone Number	:	650-941-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	4546 EL CAMINO REAL
Second Line	:	#254
City	:	LOS ALTOS
State	:	CA
Zip	:	94022-1099
Country	:	US
Telephone Number	:	650-941-2100
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALENE K BARONIAN
Credential	:	MS,RD
Telephone Number	:	650-941-2100

Provider Enumeration Date	:	06/18/2015
Last Update Date	:	06/18/2015

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