Provider Demographics
NPI:1679117220
Name:SPREAFICO, HEATHER KATHLEEN (MS, RDN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:KATHLEEN
Last Name:SPREAFICO
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 JOHNSON AVE STE 105B
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4140
Mailing Address - Country:US
Mailing Address - Phone:805-786-6170
Mailing Address - Fax:805-786-6171
Practice Address - Street 1:1941 JOHNSON AVE STE 105B
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4140
Practice Address - Country:US
Practice Address - Phone:805-786-6170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA14572010OtherCAQH PROVIEW