Healthcare Provider Details

I. General information

NPI: 1083018204
Provider Name (Legal Business Name): JOCELYN C PROTOPAPPAS RDN, MSW, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5160 1/2 W POINT LOMA BLVD
SAN DIEGO CA
92107-1315
US

IV. Provider business mailing address

5160 1/2 W POINT LOMA BLVD
SAN DIEGO CA
92107-1315
US

V. Phone/Fax

Practice location:
  • Phone: 717-683-8314
  • Fax:
Mailing address:
  • Phone: 717-683-8314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberLD-D-10190590
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI60861109
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: