Provider Demographics
NPI:1548450810
Name:MOON, PATTI PINKERTON (RD, CDE, CSSD)
Entity type:Individual
Prefix:MRS
First Name:PATTI
Middle Name:PINKERTON
Last Name:MOON
Suffix:
Gender:F
Credentials:RD, CDE, CSSD
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:EMILY
Other - Last Name:PINKERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:825 EVELYN AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1720
Mailing Address - Country:US
Mailing Address - Phone:707-365-2112
Mailing Address - Fax:
Practice Address - Street 1:825 EVELYN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706
Practice Address - Country:US
Practice Address - Phone:707-365-2112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA859707133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered