Provider Demographics
NPI:1598904609
Name:SNELL, JULIA FAITH (RD, LD, MS)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:FAITH
Last Name:SNELL
Suffix:
Gender:F
Credentials:RD, LD, MS
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:FAITH
Other - Last Name:PHEND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD, MS
Mailing Address - Street 1:576 SOLEDAD ST
Mailing Address - Street 2:
Mailing Address - City:SOLEDAD
Mailing Address - State:CA
Mailing Address - Zip Code:93960-2518
Mailing Address - Country:US
Mailing Address - Phone:831-710-7150
Mailing Address - Fax:
Practice Address - Street 1:600 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOLEDAD
Practice Address - State:CA
Practice Address - Zip Code:93960-2533
Practice Address - Country:US
Practice Address - Phone:831-678-2665
Practice Address - Fax:831-678-0776
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133V00000X
KY2147133V00000X
OH6320133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered