Provider Demographics
NPI:1538951272
Name:MCCALL, KEVIN CONRAD (RDN)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:CONRAD
Last Name:MCCALL
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 HUMBERT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-5715
Mailing Address - Country:US
Mailing Address - Phone:805-903-2134
Mailing Address - Fax:
Practice Address - Street 1:807 HUMBERT AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-5715
Practice Address - Country:US
Practice Address - Phone:805-903-2134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered