Provider Demographics
NPI:1972002855
Name:MIDDLETON, JOSEPHINE P (RD)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:P
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 LENNON LN STE 160
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-5908
Mailing Address - Country:US
Mailing Address - Phone:925-947-4545
Mailing Address - Fax:
Practice Address - Street 1:365 LENNON LN STE 160
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598
Practice Address - Country:US
Practice Address - Phone:925-947-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2020-12-08
Deactivation Date:2018-08-02
Deactivation Code:
Reactivation Date:2020-12-08
Provider Licenses
StateLicense IDTaxonomies
133VN1005X
CA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal