Healthcare Provider Details

I. General information

NPI: 1952638207
Provider Name (Legal Business Name): CORINNE ROSE KOHLEN R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2009
Last Update Date: 04/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 CASA ST SUITE 204
SAN LUIS OBISPO CA
93405-5803
US

IV. Provider business mailing address

359 LOS CERROS DR
SAN LUIS OBISPO CA
93405-1272
US

V. Phone/Fax

Practice location:
  • Phone: 805-548-8585
  • Fax: 805-548-8589
Mailing address:
  • Phone: 805-441-2281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: