MEDICARE: HEATHER SUE NEWBERRY RD

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	886510	WA

General Provider Information

NPI Number	:	1669176228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER SUE NEWBERRY RD

Provider Business Mailing Address
First Line	:	334 N 2ND ST
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95112-4015
Country	:	US
Telephone Number	:	408-722-7287
Fax Number	:

Provider Business Practice Location Address
First Line	:	334 N 2ND ST
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95112-4015
Country	:	US
Telephone Number	:	408-722-7287
Fax Number	:

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

Provider Enumeration Date	:	03/28/2023
Last Update Date	:	03/28/2023

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Directions to “ HEATHER SUE NEWBERRY RD” Practice Location

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