Healthcare Provider Details

I. General information

NPI: 1457394728
Provider Name (Legal Business Name): JUNE GNASS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 SYCAMORE LN
DURHAM CA
95938-9744
US

IV. Provider business mailing address

1900 SYCAMORE LN
DURHAM CA
95938-9744
US

V. Phone/Fax

Practice location:
  • Phone: 530-891-9357
  • Fax: 530-894-5252
Mailing address:
  • Phone: 530-891-9357
  • Fax: 530-894-5252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number718809
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: