Provider Demographics
NPI:1407454721
Name:MATEL, JULIA LYNNE (RD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:LYNNE
Last Name:MATEL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 WELCH RD STE 115
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1508
Mailing Address - Country:US
Mailing Address - Phone:650-736-2128
Mailing Address - Fax:
Practice Address - Street 1:750 WELCH RD STE 115
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1508
Practice Address - Country:US
Practice Address - Phone:650-736-2128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA861840133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric