Healthcare Provider Details

I. General information

NPI: 1407548431
Provider Name (Legal Business Name): MELISSA RICHARDSON RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 PACIFIC AVE
SAN FRANCISCO CA
94133-4681
US

IV. Provider business mailing address

595 PACIFIC AVE
SAN FRANCISCO CA
94133-4669
US

V. Phone/Fax

Practice location:
  • Phone: 451-800-2311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number977045
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: