Healthcare Provider Details

I. General information

NPI: 1992128151
Provider Name (Legal Business Name): CAROLYN J CLINE PH.D..M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2014
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SACRAMENTO ST
SAN FRANCISCO CA
94108-1918
US

IV. Provider business mailing address

1100 SACRAMENTO ST
SAN FRANCISCO CA
94108-1918
US

V. Phone/Fax

Practice location:
  • Phone: 415-441-1738
  • Fax:
Mailing address:
  • Phone: 415-441-1738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberGFE033541
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: