MEDICARE: JILL MARIE WEST R.D.

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	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1134103245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL MARIE WEST R.D.

Provider Business Mailing Address
First Line	:	3468 MT DIABLO BLVD
Second Line	:	SUITE B-201
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-3957
Country	:	US
Telephone Number	:	925-788-2937
Fax Number	:

Provider Business Practice Location Address
First Line	:	3468 MT DIABLO BLVD
Second Line	:	SUITE B-201
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-3957
Country	:	US
Telephone Number	:	925-788-2937
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	04/08/2014

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