Provider Demographics
NPI:1356358527
Name:UWATE, MARILYN (RD, MED, CDE,)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:UWATE
Suffix:
Gender:F
Credentials:RD, MED, CDE,
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:KW
Other - Last Name:UWATE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BC-ADM
Mailing Address - Street 1:PO BOX HH
Mailing Address - Street 2:BUSINESS DEVELOPMENT & CONTRACTING
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93942
Mailing Address - Country:US
Mailing Address - Phone:831-622-2716
Mailing Address - Fax:831-625-4764
Practice Address - Street 1:23625 HOLMAN HWY
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5902
Practice Address - Country:US
Practice Address - Phone:831-624-5311
Practice Address - Fax:831-625-4948
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARD418765133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP63303Medicare UPIN
CAZZZ23847ZMedicare ID - Type Unspecified