Provider Demographics
NPI:1376682591
Name:QUINLAN, MARY B (RD, MPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:B
Last Name:QUINLAN
Suffix:
Gender:F
Credentials:RD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 ANGELICA CT
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-1327
Mailing Address - Country:US
Mailing Address - Phone:415-971-5961
Mailing Address - Fax:
Practice Address - Street 1:17 ANGELICA CT
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-1327
Practice Address - Country:US
Practice Address - Phone:415-971-5961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA597928133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered