Individual
AMELIA UNDERWOOD I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, CDE, PA-C
Contact information
Practice address
591 MCCRAY ST STE 231, HOLLISTER, CA 95023-2224
(831) 444-2289
Mailing address
591 MCCRAY ST STE 231, HOLLISTER, CA 95023-2224
(831) 444-2289
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
—
—
133V00000X
Registered Dietitian
—
—
363A00000X
Physician Assistant
Primary
53421
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
53421
PHYSICIAN ASSISTANT
CA
Enumeration date
06/28/2016
Last updated
06/28/2016
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