Provider Demographics
NPI:1316355803
Name:MOUNT, MELINDA (RD)
Entity type:Individual
Prefix:MISS
First Name:MELINDA
Middle Name:
Last Name:MOUNT
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 1:2664 SENTER RD
Mailing Address - Street 2:APT 220
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-1171
Mailing Address - Country:US
Mailing Address - Phone:408-348-8087
Mailing Address - Fax:
Practice Address - Street 1:2664 SENTER RD
Practice Address - Street 2:APT 220
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111-1171
Practice Address - Country:US
Practice Address - Phone:408-348-8087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA955618133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered