Healthcare Provider Details

I. General information

NPI: 1952865636
Provider Name (Legal Business Name): JAMIE MOULDING RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2019
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11985 HERITAGE OAK PL STE 100
AUBURN CA
95603-2413
US

IV. Provider business mailing address

2780 ALLEN DR
AUBURN CA
95602-9649
US

V. Phone/Fax

Practice location:
  • Phone: 916-225-1781
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1068693
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: