Organization
DIABETES SOCIETY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CAROL D KASSOUF (EXECUTIVE DIRECTOR)
(510) 331-8620
Entity
Organization
Contact information
Practice address
1165 LINCOLN AVE, #300, SAN JOSE, CA 95125-3038
(408) 287-3785
(408) 287-2701
Mailing address
1165 LINCOLN AVE, #300, SAN JOSE, CA 95125-3038
(408) 287-3785
(408) 287-2701
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
—
—
136A00000X
Registered Dietetic Technician
—
—
174400000X
Specialist
—
—
174H00000X
Health Educator
Primary
—
—
Other
Enumeration date
07/17/2006
Last updated
06/21/2010
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