MEDICARE: KATIE GRIGSBY 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	988677	CA

General Provider Information

NPI Number	:	1891280806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE GRIGSBY RD

Provider Business Mailing Address
First Line	:	820 AUDREY CT
Second Line	:
City	:	PLEASANT HILL
State	:	CA
Zip	:	94523-1904
Country	:	US
Telephone Number	:	619-436-8287
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 AUDREY CT
Second Line	:
City	:	PLEASANT HILL
State	:	CA
Zip	:	94523-1904
Country	:	US
Telephone Number	:	619-436-8287
Fax Number	:

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

Provider Enumeration Date	:	06/22/2018
Last Update Date	:	11/24/2021

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