Provider Demographics
NPI:1710314729
Name:JOHNSTON, EMILY MEDVED (MS, RD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MEDVED
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 W JULIAN ST
Mailing Address - Street 2:APT 252
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95110-2451
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:MOSS BEACH
Practice Address - State:CA
Practice Address - Zip Code:94038-9645
Practice Address - Country:US
Practice Address - Phone:510-599-1169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered