Individual
KATHY BOURQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
5478 ONTARIO CMN, FREMONT, CA 94555-2928
(510) 648-2345
Mailing address
5478 ONTARIO CMN, FREMONT, CA 94555-2928
(510) 648-2345
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1066457
CA
Other
Enumeration date
05/29/2015
Last updated
05/29/2015
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