Healthcare Provider Details

I. General information

NPI: 1013683267
Provider Name (Legal Business Name): BARRY PATRICK CONRAD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 WELCH RD
PALO ALTO CA
94304-1601
US

IV. Provider business mailing address

725 WELCH RD
PALO ALTO CA
94304-1601
US

V. Phone/Fax

Practice location:
  • Phone: 650-721-1811
  • Fax:
Mailing address:
  • Phone: 650-498-7353
  • Fax: 650-725-8375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number876319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: