Provider Demographics
NPI:1558583302
Name:DODSON, BARBARA ELAINE
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:ELAINE
Last Name:DODSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BARBARA
Other - Middle Name:ELAINE
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSRD,IBCLC
Mailing Address - Street 1:6842 CASTLEROCK DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-4713
Mailing Address - Country:US
Mailing Address - Phone:408-997-1839
Mailing Address - Fax:
Practice Address - Street 1:700 LAWRENCE EXPRESSAY
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-4713
Practice Address - Country:US
Practice Address - Phone:408-997-1839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric