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General NPI Number Information
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NPI Number | 1043431224
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Entity Type | Individual
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Provider Name | AUDREY DAVIS OLIVER REGISTERED DIETITIAN
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Gender | Female
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 375 LAGUNA HONDA BLVD
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City | SAN FRANCISCO
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State | CA
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Zip | 94116
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Country | US
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Telephone | 415-759-3300
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Fax | 415-759-3317
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Provider Business Mailing Address
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Address Line | 61 ALTA VISTA WAY
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City | DALY CITY
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State | CA
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Zip | 94014
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Country | US
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Telephone | 415-585-0370
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Fax | 415-759-3317
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 139950
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License Number State | CA
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