Provider Demographics
NPI:1285813097
Name:COLLINS, KATHRYN (RD)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:COLLINS
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 1:361 SPRING BREEZE CT.
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-0838
Mailing Address - Country:US
Mailing Address - Phone:805-217-8383
Mailing Address - Fax:
Practice Address - Street 1:227 JANSS ROAD
Practice Address - Street 2:110
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1854
Practice Address - Country:US
Practice Address - Phone:805-217-8383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL805603133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWNT805603AMedicare PIN
CAWNT805603BMedicare PIN