MEDICARE: CLARISSA HOM MPH, RD

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	133VN1004X	Pediatric Nutrition Registered Dietitian

General Provider Information

NPI Number	:	1831961226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARISSA HOM MPH, RD

Provider Business Mailing Address
First Line	:	1900 OFARRELL ST STE 250
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94403-1387
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 OFARRELL ST STE 250
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94403-1387
Country	:	US
Telephone Number	:	650-422-7475
Fax Number	:

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

Provider Enumeration Date	:	10/27/2023
Last Update Date	:	10/20/2025

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