=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972323806
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RABEHA ANJUM KAISER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2024
-----------------------------------------------------
Last Update Date | 10/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2150 PASTORAL LOOP
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-800-3020
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3277 S WHITE RD # 765
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95148-4056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-800-3020
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RABEHA KAISER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 408-800-3020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133N00000X
-----------------------------------------------------
Taxonomy Name | Nutritionist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------