Provider Demographics
NPI:1972305571
Name:CONGDON, STEPHANIE L (RDN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:CONGDON
Suffix:
Gender:
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13436 EL PRESIDIO TRL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-1419
Mailing Address - Country:US
Mailing Address - Phone:619-400-9583
Mailing Address - Fax:
Practice Address - Street 1:13436 EL PRESIDIO TRL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-1419
Practice Address - Country:US
Practice Address - Phone:619-400-9583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered