MEDICARE: KRISTI JONEA MATTHEWS REGISTERED DIETITIAN

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	86083320	CA

General Provider Information

NPI Number	:	1770082802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTI JONEA MATTHEWS REGISTERED DIETITIAN

Provider Business Mailing Address
First Line	:	1090 LOS ALTOS DR
Second Line	:
City	:	HOLLISTER
State	:	CA
Zip	:	95023-5156
Country	:	US
Telephone Number	:	831-801-3484
Fax Number	:

Provider Business Practice Location Address
First Line	:	930 SUNNYSLOPE RD STE A2
Second Line	:
City	:	HOLLISTER
State	:	CA
Zip	:	95023-5616
Country	:	US
Telephone Number	:	831-637-2022
Fax Number	:	831-637-2100

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

Provider Enumeration Date	:	02/04/2018
Last Update Date	:	05/27/2021

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