Provider Demographics
NPI:1649884446
Name:RODGERS, MAURA (RD)
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:
Last Name:RODGERS
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 1:1735 STEINER ST APT 478
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-5200
Mailing Address - Country:US
Mailing Address - Phone:603-440-3255
Mailing Address - Fax:
Practice Address - Street 1:1735 STEINER ST APT 478
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-5200
Practice Address - Country:US
Practice Address - Phone:603-440-3255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86115213133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered