Provider Demographics
NPI:1992128151
Name:CLINE, CAROLYN J (PHDMD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:J
Last Name:CLINE
Suffix:
Gender:F
Credentials:PHDMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 SACRAMENTO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-1918
Mailing Address - Country:US
Mailing Address - Phone:415-441-1738
Mailing Address - Fax:
Practice Address - Street 1:1100 SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-1918
Practice Address - Country:US
Practice Address - Phone:415-441-1738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGFE033541133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education