Provider Demographics
NPI:1497802987
Name:THOMPSON, JACQUELINE ANNE (RD, CDE)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:ANNE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 CONCORD CT
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-4003
Mailing Address - Country:US
Mailing Address - Phone:831-277-6283
Mailing Address - Fax:
Practice Address - Street 1:85 NEILSON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2485
Practice Address - Country:US
Practice Address - Phone:831-763-6445
Practice Address - Fax:831-724-0877
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA883567133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ26777ZMedicare ID - Type UnspecifiedINDIV PROVIDER NUMBER
CAZZZ03100ZMedicare ID - Type UnspecifiedLINK TO PVCHT