Healthcare Provider Details

I. General information

NPI: 1346339488
Provider Name (Legal Business Name): MEGAN KELLY WINSLOW R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PORTER DR SUITE 300
SAN RAMON CA
94583-1587
US

IV. Provider business mailing address

2531 RIVERS BEND CIRCLE
LIVERMORE CA
94550
US

V. Phone/Fax

Practice location:
  • Phone: 925-314-2547
  • Fax:
Mailing address:
  • Phone: 925-215-5502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number949158
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: