Healthcare Provider Details

I. General information

NPI: 1487707543
Provider Name (Legal Business Name): ANITA MARIE KOBUSZEWSKI M.S., R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3132 MARINA DR
ALAMEDA CA
94501-1640
US

IV. Provider business mailing address

PO BOX 1646
ALAMEDA CA
94501-0182
US

V. Phone/Fax

Practice location:
  • Phone: 510-910-6694
  • Fax:
Mailing address:
  • Phone: 510-910-6694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number706004
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: