Provider Demographics
NPI:1720320880
Name:YODER, KATRINA (RD, CDE)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:YODER
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 WEST BUNNY AVENUE
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-2805
Mailing Address - Country:US
Mailing Address - Phone:805-739-3957
Mailing Address - Fax:805-739-3958
Practice Address - Street 1:116 SOUTH PALISADE DRIVE
Practice Address - Street 2:SUITE 104
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8905
Practice Address - Country:US
Practice Address - Phone:805-739-3957
Practice Address - Fax:805-739-3958
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1081231133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB243165OtherMEDICARE ID