Provider Demographics
NPI:1174011522
Name:SMITH, JENNA VERA (RD)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:VERA
Last Name:SMITH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:VERA
Other - Last Name:GAILEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:1304 OAKBRIAR CIR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-9662
Mailing Address - Country:US
Mailing Address - Phone:925-487-9503
Mailing Address - Fax:
Practice Address - Street 1:2131 CAPITOL AVE STE 206
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5755
Practice Address - Country:US
Practice Address - Phone:925-487-9503
Practice Address - Fax:916-404-0431
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86069746133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered