MEDICARE: CLAIRE RUTH COFFRIN-ST. JULIEN 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	86030074	CA

General Provider Information

NPI Number	:	1780297523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAIRE RUTH COFFRIN-ST. JULIEN REGISTERED DIETITIAN

Provider Business Mailing Address
First Line	:	1201 COMMERCE AVE
Second Line	:
City	:	ATWATER
State	:	CA
Zip	:	95301-5224
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 COMMERCE AVE
Second Line	:
City	:	ATWATER
State	:	CA
Zip	:	95301-5224
Country	:	US
Telephone Number	:	209-358-7681
Fax Number	:

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

Provider Enumeration Date	:	08/30/2020
Last Update Date	:	06/29/2021

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Directions to “ CLAIRE RUTH COFFRIN-ST. JULIEN REGISTERED DIETITIAN” Practice Location

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