Individual
COLETTE ROSE MICKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
REGISTERED DIETITIAN
Contact information
Practice address
1132 CARNFORTH CT, SAN JOSE, CA 95120-4212
(805) 714-8723
Mailing address
1132 CARNFORTH CT, SAN JOSE, CA 95120-4212
(805) 714-8723
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86032820
CA
Other
Enumeration date
11/17/2015
Last updated
04/25/2022
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