Healthcare Provider Details

I. General information

NPI: 1710314729
Provider Name (Legal Business Name): EMILY MEDVED JOHNSTON M.S., R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2013
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CYPRESS AVE
MOSS BEACH CA
94038-9645
US

IV. Provider business mailing address

39 W JULIAN ST APT 252
SAN JOSE CA
95110-2451
US

V. Phone/Fax

Practice location:
  • Phone: 510-599-1169
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: