Healthcare Provider Details

I. General information

NPI: 1447169560
Provider Name (Legal Business Name): MARIA RASPOLIC MS,RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 S BASCOM AVE
SAN JOSE CA
95128-2604
US

IV. Provider business mailing address

751 S BASCOM AVE
SAN JOSE CA
95128-2604
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-2925
  • Fax: 408-885-3357
Mailing address:
  • Phone: 408-885-2925
  • Fax: 408-885-3357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number870916
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: