Provider Demographics
NPI:1821048414
Name:MCGREGOR, MARLA J (RD)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:J
Last Name:MCGREGOR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MARLA
Other - Middle Name:J
Other - Last Name:NAWROCKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1541 FLORIDA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4438
Mailing Address - Country:US
Mailing Address - Phone:209-577-3388
Mailing Address - Fax:209-523-7583
Practice Address - Street 1:1541 FLORIDA AVE STE 200
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4438
Practice Address - Country:US
Practice Address - Phone:209-577-3388
Practice Address - Fax:209-523-7583
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA724348133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C265180Medicaid
CA00C265180Medicaid
CAZZZ24620ZMedicare ID - Type UnspecifiedMEDICARE NUMBER