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General NPI Number Information
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NPI Number | 1154334456
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Entity Type | Individual
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Provider Name | ROSARIO MARCOS MARTIRES RD
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Gender | Female
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 795 WILLOW RD
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City | MENLO PARK
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State | CA
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Zip | 94025-2539
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Country | US
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Telephone | 165-049-3500
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Fax | 650-617-2635
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Provider Business Mailing Address
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Address Line | 4451 MACBETH CIRCLE
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City | FREMONT
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State | CA
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Zip | 94555-2106
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Country | US
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Telephone | 151-074-5085
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Fax |
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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 | 373312
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License Number State |
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