Healthcare Provider Details

I. General information

NPI: 1871030353
Provider Name (Legal Business Name): DIETS AND LIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2017
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4135 VOLTAIRE ST
SAN JOSE CA
95148-4356
US

IV. Provider business mailing address

4135 VOLTAIRE ST
SAN JOSE CA
95148-4356
US

V. Phone/Fax

Practice location:
  • Phone: 408-802-6684
  • Fax:
Mailing address:
  • Phone: 408-802-6684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: PURVI SHAH
Title or Position: REGISTERED DIETITIAN NUTRITIONIST
Credential: RDN
Phone: 408-802-6684