Provider Demographics
NPI:1922218221
Name:SCHROEDER, HOLLY MAY (RD, CNSD)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:MAY
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:RD, CNSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4533 IDAHO ST # 1
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-3154
Mailing Address - Country:US
Mailing Address - Phone:858-939-4269
Mailing Address - Fax:858-939-4948
Practice Address - Street 1:3003 HEALTH CENTER DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2700
Practice Address - Country:US
Practice Address - Phone:858-939-4269
Practice Address - Fax:858-939-4269
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA715435133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric