Provider Demographics
NPI:1184922197
Name:FREEMAN, KAREN (MS, RD, CSSD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:MS, RD, CSSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12395 EL CAMINO REAL
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SAN DIEGO
Mailing Address - State:NY
Mailing Address - Zip Code:92130
Mailing Address - Country:US
Mailing Address - Phone:858-259-7777
Mailing Address - Fax:858-259-7777
Practice Address - Street 1:12395 EL CAMINO REAL
Practice Address - Street 2:SUITE 115
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130
Practice Address - Country:US
Practice Address - Phone:858-259-7777
Practice Address - Fax:858-259-7777
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY528450133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA528450OtherAMERICAN DIETETIC ASSOCIATION REGISTRATION NUMBER