Provider Demographics
NPI:1023495983
Name:MARGOLIS, JODY S (MS, RD)
Entity type:Individual
Prefix:MRS
First Name:JODY
Middle Name:S
Last Name:MARGOLIS
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 COASTAL OAK LN
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-4940
Mailing Address - Country:US
Mailing Address - Phone:949-533-0690
Mailing Address - Fax:
Practice Address - Street 1:8 COASTAL OAK LN
Practice Address - Street 2:
Practice Address - City:TRABUCO CANYON
Practice Address - State:CA
Practice Address - Zip Code:92679-4940
Practice Address - Country:US
Practice Address - Phone:949-533-0690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered