Provider Demographics
NPI:1891146544
Name:PREIS, JULIE MARIE (RD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:PREIS
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 1:810 OAK GROVE RD
Mailing Address - Street 2:APT 98
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-3562
Mailing Address - Country:US
Mailing Address - Phone:925-817-7926
Mailing Address - Fax:
Practice Address - Street 1:200 MUIR RD
Practice Address - Street 2:HACIENDA BUILDING
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4614
Practice Address - Country:US
Practice Address - Phone:925-372-7438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85002140133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal