Provider Demographics
NPI:1679950349
Name:LOPEZ, KIMBERLY ROSANNE NGUYEN (RD)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ROSANNE NGUYEN
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:HIBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:749 ELM ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-1810
Mailing Address - Country:US
Mailing Address - Phone:408-421-1086
Mailing Address - Fax:
Practice Address - Street 1:700 LAWRENCE EXPY
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-5173
Practice Address - Country:US
Practice Address - Phone:408-851-0406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86043775133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered