Basic Information
Provider Information
NPI: 1003141854
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KECK
FirstName: REBEKAH
MiddleName: LYNN
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 700 LAWRENCE EXPY
Address2:  
City: SANTA CLARA
State: CA
PostalCode: 950515173
CountryCode: US
TelephoneNumber: 4084757208
FaxNumber:  
Practice Location
Address1: 700 LAWRENCE EXPY
Address2:  
City: SANTA CLARA
State: CA
PostalCode: 950515173
CountryCode: US
TelephoneNumber: 4084757208
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/13/2009
LastUpdateDate: 10/13/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
133V00000X1035315CAY Dietary & Nutritional Service ProvidersDietitian, Registered 

No ID Information.


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