Provider Demographics
NPI:1982237871
Name:FARRICKER, ZOE (RDN)
Entity type:Individual
Prefix:
First Name:ZOE
Middle Name:
Last Name:FARRICKER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2138 ADAMS AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-1245
Mailing Address - Country:US
Mailing Address - Phone:508-479-4569
Mailing Address - Fax:
Practice Address - Street 1:203 OAK ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1344
Practice Address - Country:US
Practice Address - Phone:508-653-4633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86051848133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered