Provider Demographics
NPI:1023885530
Name:MURPHY, MADISON KATHLEEN (MS, RDN)
Entity type:Individual
Prefix:MRS
First Name:MADISON
Middle Name:KATHLEEN
Last Name:MURPHY
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 3RD AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4927
Mailing Address - Country:US
Mailing Address - Phone:714-351-0608
Mailing Address - Fax:
Practice Address - Street 1:3520 3RD AVE APT 301
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4927
Practice Address - Country:US
Practice Address - Phone:714-351-0608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA086343186133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered