Provider Demographics
NPI:1396976809
Name:COHEN, HEATHER MCCRACKEN (MPH, RD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MCCRACKEN
Last Name:COHEN
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 PENROSE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-2351
Mailing Address - Country:US
Mailing Address - Phone:858-525-1982
Mailing Address - Fax:858-452-6700
Practice Address - Street 1:3262 HOLIDAY CT
Practice Address - Street 2:SUITE 208
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-0026
Practice Address - Country:US
Practice Address - Phone:858-525-1982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered