Provider Demographics
NPI:1861603441
Name:STELLMON, KANDICE
Entity type:Individual
Prefix:
First Name:KANDICE
Middle Name:
Last Name:STELLMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 EL CAMINO REAL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-3948
Mailing Address - Country:US
Mailing Address - Phone:650-595-5437
Mailing Address - Fax:650-595-5438
Practice Address - Street 1:1601 EL CAMINO REAL
Practice Address - Street 2:SUITE 101
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-3948
Practice Address - Country:US
Practice Address - Phone:650-595-5437
Practice Address - Fax:650-595-5438
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist