MEDICARE: ERICKA SUZANNE DOOLITTLE RD, MPH

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		CA

General Provider Information

NPI Number	:	1659595338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICKA SUZANNE DOOLITTLE RD, MPH

Provider Business Mailing Address
First Line	:	2122 LAKESHORE AVE APT 602
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94606-1110
Country	:	US
Telephone Number	:	510-499-1086
Fax Number	:

Provider Business Practice Location Address
First Line	:	2122 LAKESHORE AVE APT 602
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94606-1110
Country	:	US
Telephone Number	:	510-499-1086
Fax Number	:

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

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	07/08/2007

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