Healthcare Provider Details

I. General information

NPI: 1962411140
Provider Name (Legal Business Name): ANN - POCAPALIA RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 S SAN MATEO DR SUITE 380
SAN MATEO CA
94401-3857
US

IV. Provider business mailing address

50 S SAN MATEO DR SUITE 380
SAN MATEO CA
94401-3857
US

V. Phone/Fax

Practice location:
  • Phone: 650-591-8228
  • Fax: 650-591-6430
Mailing address:
  • Phone: 650-591-8228
  • Fax: 650-591-6430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number16977
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number16977
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: