Provider Demographics
NPI:1437207990
Name:KOOS, DEBORAH LORRAINE (RD, MS, CDE)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LORRAINE
Last Name:KOOS
Suffix:
Gender:F
Credentials:RD, MS, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 LENNON LN
Mailing Address - Street 2:HEALTH EDUCATION DEPARTMENT
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2419
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:320 LENNON LN
Practice Address - Street 2:HEALTH EDUCATION DEPARTMENT
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2419
Practice Address - Country:US
Practice Address - Phone:925-906-2190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered