Healthcare Provider Details

I. General information

NPI: 1518742394
Provider Name (Legal Business Name): KATHLEEN GOLD REGISTERED DIETICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CALIFORNIA DR
YOUNTVILLE CA
94599-1411
US

IV. Provider business mailing address

100 CALIFORNIA DR
YOUNTVILLE CA
94599-1411
US

V. Phone/Fax

Practice location:
  • Phone: 707-944-4506
  • Fax: 707-944-5052
Mailing address:
  • Phone: 707-944-4506
  • Fax: 707-944-5052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86341899
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: