Provider Demographics
NPI:1033663372
Name:DIETITIAN APPOINTMENT LLC
Entity Type:Organization
Organization Name:DIETITIAN APPOINTMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DEFRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-861-3447
Mailing Address - Street 1:1100 QUAIL ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 QUAIL ST
Practice Address - Street 2:SUITE 110
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2701
Practice Address - Country:US
Practice Address - Phone:949-861-3447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty