Healthcare Provider Details

I. General information

NPI: 1356358527
Provider Name (Legal Business Name): MARILYN UWATE R.D., M.ED., C.D.E.,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARILYN K.W. UWATE BC-ADM

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23625 HOLMAN HWY
MONTEREY CA
93940-5902
US

IV. Provider business mailing address

PO BOX HH BUSINESS DEVELOPMENT & CONTRACTING
MONTEREY CA
93942
US

V. Phone/Fax

Practice location:
  • Phone: 831-624-5311
  • Fax: 831-625-4948
Mailing address:
  • Phone: 831-622-2716
  • Fax: 831-625-4764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberRD418765
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: