Provider Demographics
NPI:1083136956
Name:LORD, VANESSA (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:LORD
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 SANTA MARGUARITA DR
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-4814
Mailing Address - Country:US
Mailing Address - Phone:714-273-7704
Mailing Address - Fax:
Practice Address - Street 1:520 SANTA MARGUARITA DR
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-4814
Practice Address - Country:US
Practice Address - Phone:714-273-7704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered