Basic Information
| Provider Information | |||||||||
| NPI: | 1548513567 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KHAN | ||||||||
| FirstName: | SHAHLA | ||||||||
| MiddleName: | DEBA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | R.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 FENNEL CT | ||||||||
| Address2: | |||||||||
| City: | MORGAN HILL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950372506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6617332939 | ||||||||
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| Practice Location | |||||||||
| Address1: | 351 FELICE DR | ||||||||
| Address2: | |||||||||
| City: | HOLLISTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950233361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316375306 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2012 | ||||||||
| LastUpdateDate: | 10/16/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 1071185 | CA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.