Provider Demographics
NPI:1114570876
Name:BERGER, KATHERINE (RD)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:BERGER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MRS
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:BERGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:967 W HEDDING ST STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-1259
Mailing Address - Country:US
Mailing Address - Phone:858-205-9478
Mailing Address - Fax:
Practice Address - Street 1:967 W HEDDING ST STE 110
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1259
Practice Address - Country:US
Practice Address - Phone:858-205-9478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA001091091133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1114570876OtherNPI