Provider Demographics
NPI:1043564537
Name:PEARSON, KENDRA J (RD)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:J
Last Name:PEARSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:J
Other - Last Name:LADJIMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91785-0032
Mailing Address - Country:US
Mailing Address - Phone:909-905-0509
Mailing Address - Fax:
Practice Address - Street 1:170 C ST APT 3
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6063
Practice Address - Country:US
Practice Address - Phone:949-409-6891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2022-09-19
Deactivation Date:2014-12-05
Deactivation Code:
Reactivation Date:2022-05-05
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management