Provider Demographics
NPI:1043537806
Name:VAN ROOYEN, KRISTEN ROUHE (RD)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:ROUHE
Last Name:VAN ROOYEN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 LAS LUNAS ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-2047
Mailing Address - Country:US
Mailing Address - Phone:626-844-6568
Mailing Address - Fax:
Practice Address - Street 1:3160 LAS LUNAS ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-2047
Practice Address - Country:US
Practice Address - Phone:626-844-6568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA809157133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric