Active NPI
Colette Rose Micko, REGISTERED DIETITIAN
- Registered Dietitian
- San Jose, CA
National Provider Identifier
1336513118
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86032820
- Practice address
- 1132 Carnforth CT
San Jose, CA 95120-4212 - Phone
- (805) 714-8723
- NPI assigned
- Nov 17, 2015
- Last updated
- Apr 25, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 86032820 | CA | Primary |
Addresses
Primary practice location
1132 Carnforth CT
San Jose, CA 95120-4212
Mailing address
1132 Carnforth CT
San Jose, CA 95120-4212
Phone (805) 714-8723
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86032820 | CA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1447718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1650844800000",
"number": "1336513118",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1132 CARNFORTH CT",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951204212",
"telephone_number": "805-714-8723"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1132 CARNFORTH CT",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951204212",
"telephone_number": "805-714-8723"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICKO",
"first_name": "COLETTE",
"middle_name": "ROSE",
"credential": "REGISTERED DIETITIAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-11-17",
"last_updated": "2022-04-25",
"certification_date": "2022-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "86032820",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.