MEDICARE: DIABETES SOCIETY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	136A00000X	Registered Dietetic Technician
2	133N00000X	Nutritionist
3	174400000X	Specialist
4	174H00000X	Health Educator

General Provider Information

NPI Number	:	1326065160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIABETES SOCIETY

Provider Business Mailing Address
First Line	:	1165 LINCOLN AVE
Second Line	:	#300
City	:	SAN JOSE
State	:	CA
Zip	:	95125-3038
Country	:	US
Telephone Number	:	408-287-3785
Fax Number	:	408-287-2701

Provider Business Practice Location Address
First Line	:	1165 LINCOLN AVE
Second Line	:	#300
City	:	SAN JOSE
State	:	CA
Zip	:	95125-3038
Country	:	US
Telephone Number	:	408-287-3785
Fax Number	:	408-287-2701

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. CAROL D KASSOUF
Credential	:
Telephone Number	:	510-331-8620

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	06/21/2010

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Directions to “DIABETES SOCIETY ” Practice Location

Language	Start Address	Practice Location

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