Provider Demographics
NPI:1386912434
Name:MCCABE, JILLIAN KAYE (MD, RD)
Entity type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:KAYE
Last Name:MCCABE
Suffix:
Gender:F
Credentials:MD, RD
Other - Prefix:DR
Other - First Name:JILLIAN
Other - Middle Name:KAYE
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, RD
Mailing Address - Street 1:979 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2136
Mailing Address - Country:US
Mailing Address - Phone:801-408-5046
Mailing Address - Fax:
Practice Address - Street 1:2121 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2303
Practice Address - Country:US
Practice Address - Phone:310-315-6125
Practice Address - Fax:310-582-7163
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8134725-4901133V00000X
390200000X
CAA185140208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program