Provider Demographics
NPI:1568248698
Name:PECK, HOLLY BENSON (RDN)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:BENSON
Last Name:PECK
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19438 DESIREE LN
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:95258-9264
Mailing Address - Country:US
Mailing Address - Phone:408-623-4290
Mailing Address - Fax:
Practice Address - Street 1:19438 DESIREE LN
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CA
Practice Address - Zip Code:95258-9264
Practice Address - Country:US
Practice Address - Phone:408-623-4290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01018929133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered