Healthcare Provider Details

I. General information

NPI: 1477863462
Provider Name (Legal Business Name): KATHLEEN RUTH WEBSTER MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 MOORPARK AVE STE 218
SAN JOSE CA
95128-2632
US

IV. Provider business mailing address

2211 MOORPARK AVENUE STE 218
SAN JOSE CA
95128-2654
US

V. Phone/Fax

Practice location:
  • Phone: 408-998-2325
  • Fax: 408-998-2022
Mailing address:
  • Phone: 408-998-2325
  • Fax: 408-998-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number727137
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: