Provider Demographics
NPI:1497410120
Name:MCCARTHY, MAUREEN MARGARET (RD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:MARGARET
Last Name:MCCARTHY
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 1:77777 COUNTRY CLUB DR APT 286
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-0466
Mailing Address - Country:US
Mailing Address - Phone:760-408-7075
Mailing Address - Fax:
Practice Address - Street 1:4210 RIVERWALK PKWY STE 400
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3313
Practice Address - Country:US
Practice Address - Phone:760-408-7075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA715291133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered