Provider Demographics
NPI:1144010141
Name:CONWAY, CAMERON (RDN)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:CONWAY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9240 MINERS XING
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650-7734
Mailing Address - Country:US
Mailing Address - Phone:650-906-8131
Mailing Address - Fax:
Practice Address - Street 1:111 MAIN ST STE F
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-2914
Practice Address - Country:US
Practice Address - Phone:650-906-8131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86420186133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered