Healthcare Provider Details

I. General information

NPI: 1366585275
Provider Name (Legal Business Name): LAURA YIP R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 11TH ST
OAKLAND CA
94607-4841
US

IV. Provider business mailing address

168 11TH ST
OAKLAND CA
94607-4841
US

V. Phone/Fax

Practice location:
  • Phone: 510-839-2022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number953445
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: