Active NPI
Prabha Tadiboyana, DIETITIAN
- Registered Dietitian
- San Leandro, CA
National Provider Identifier
1568512804
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 943807
- Practice address
- 1440 168TH Avenue
Kaiser Post Acute Care Center
San Leandro, CA 94578 - Phone
- (510) 481-6319
- NPI assigned
- Jan 11, 2007
- 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 | 943807 | Primary |
Addresses
Primary practice location
1440 168TH Avenue
Kaiser Post Acute Care Center
San Leandro, CA 94578
Mailing address
20800 Homestead Rd
Apt # 17 G
Cupertino, CA 95014-0458
Phone (408) 517-0992
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1568512804",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20800 HOMESTEAD RD",
"address_2": "APT # 17 G",
"city": "CUPERTINO",
"state": "CA",
"postal_code": "950140458",
"telephone_number": "408-517-0992"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1440 168TH AVENUE",
"address_2": "KAISER POST ACUTE CARE CENTER",
"city": "SAN LEANDRO",
"state": "CA",
"postal_code": "94578",
"telephone_number": "510-481-6319"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TADIBOYANA",
"first_name": "PRABHA",
"credential": "DIETITIAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": "943807",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Leandro, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.