Healthcare Provider Details

I. General information

NPI: 1952999823
Provider Name (Legal Business Name): JOCELYN MICHELLE FRY RD, CSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 WELCH RD STE 214
PALO ALTO CA
94304-1509
US

IV. Provider business mailing address

239 SAN JOSE AVE
SAN FRANCISCO CA
94110-3720
US

V. Phone/Fax

Practice location:
  • Phone: 650-497-3941
  • Fax: 650-736-2130
Mailing address:
  • Phone: 530-575-8037
  • Fax: 650-736-2130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: