Provider Demographics
NPI:1689028532
Name:MCCOIG, KACEY (RDN, MPH)
Entity Type:Individual
Prefix:
First Name:KACEY
Middle Name:
Last Name:MCCOIG
Suffix:
Gender:F
Credentials:RDN, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 CLAIREMONT DR
Mailing Address - Street 2:APT 4
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-6454
Mailing Address - Country:US
Mailing Address - Phone:619-850-1570
Mailing Address - Fax:
Practice Address - Street 1:3215 CLAIREMONT DR
Practice Address - Street 2:APT 4
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6454
Practice Address - Country:US
Practice Address - Phone:619-850-1570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX970161133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered