Provider Demographics
NPI:1730700139
Name:WALDORF, HEATHER (RD)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:WALDORF
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MRS
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:WALDORF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CDR 833915
Mailing Address - Street 1:2 SUTRO CT
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-2809
Mailing Address - Country:US
Mailing Address - Phone:415-377-7738
Mailing Address - Fax:
Practice Address - Street 1:1001 POTRERO AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-279-7362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
833915133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered