Provider Demographics
NPI:1689104606
Name:LEGNITTO, KACEY MARALYN (MS, RD, CEDRD)
Entity Type:Individual
Prefix:
First Name:KACEY
Middle Name:MARALYN
Last Name:LEGNITTO
Suffix:
Gender:F
Credentials:MS, RD, CEDRD
Other - Prefix:
Other - First Name:KACEY
Other - Middle Name:
Other - Last Name:LEGNITTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, RD, CEDRD
Mailing Address - Street 1:PO BOX 2832, 1070 COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:EL GRANADA
Mailing Address - State:CA
Mailing Address - Zip Code:94018
Mailing Address - Country:US
Mailing Address - Phone:805-416-6533
Mailing Address - Fax:
Practice Address - Street 1:200 TAMAL PLZ STE 130
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1195
Practice Address - Country:US
Practice Address - Phone:805-416-6533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-13
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86031562133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered