Healthcare Provider Details

I. General information

NPI: 1578990172
Provider Name (Legal Business Name): LINDA C HUIE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 08/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 MOORPARK AVE STE 218
SAN JOSE CA
95128-2629
US

IV. Provider business mailing address

1150 S BASCOM AVE, STE 26 BAY AREA COMMUNITY DIABETES EDUCATORS
SAN JOSE CA
95128-3509
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 TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number721320
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number721320
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: