Healthcare Provider Details

I. General information

NPI: 1275596215
Provider Name (Legal Business Name): JULIE SHOFFNER ROGERS MS, RD, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD RM G102
SACRAMENTO CA
95817-2201
US

IV. Provider business mailing address

4513 MYKONOS WAY
ELK GROVE CA
95758-7004
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-5256
  • Fax: 916-734-2569
Mailing address:
  • Phone: 916-394-0541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number819432
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: