Provider Demographics
NPI:1508345430
Name:GERRISH, HEATHER (MS, RDN, ASCM EP-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:GERRISH
Suffix:
Gender:F
Credentials:MS, RDN, ASCM EP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14777 LOS GATOS BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2059
Mailing Address - Country:US
Mailing Address - Phone:253-307-1987
Mailing Address - Fax:
Practice Address - Street 1:14777 LOS GATOS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2059
Practice Address - Country:US
Practice Address - Phone:253-307-1987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86071684133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered