Basic Information
| Provider Information | |||||||||
| NPI: | 1003141854 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KECK | ||||||||
| FirstName: | REBEKAH | ||||||||
| MiddleName: | LYNN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 LAWRENCE EXPY | ||||||||
| Address2: | |||||||||
| City: | SANTA CLARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950515173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4084757208 | ||||||||
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| 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 | ||||||||
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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 | 1035315 | CA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.