MEDICARE: GALE ASHWORTH RD, MS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	5893039	CA

General Provider Information

NPI Number	:	1619187796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GALE ASHWORTH RD, MS

Provider Business Mailing Address
First Line	:	2025 MORSE AVE
Second Line	:	DEPT OF PEDIATRIC SUBSPECIALTIES, STATION 1 B
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-2115
Country	:	US
Telephone Number	:	916-973-5568
Fax Number	:	916-973-7338

Provider Business Practice Location Address
First Line	:	2025 MORSE AVE
Second Line	:	DEPT OF PEDIATRIC SUBSPECIALTIES, STATION 1 B
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-2115
Country	:	US
Telephone Number	:	916-973-5568
Fax Number	:	916-973-7338

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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