Provider Demographics
NPI:1619017241
Name:MCFADDEN, KATHERINE (RD, CDE)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5092
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-0092
Mailing Address - Country:US
Mailing Address - Phone:510-649-1573
Mailing Address - Fax:510-887-2470
Practice Address - Street 1:215 W BEAMER ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-2510
Practice Address - Country:US
Practice Address - Phone:530-405-2900
Practice Address - Fax:530-204-5255
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA706478133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ25683ZMedicare UPIN