Provider Demographics
NPI:1184847378
Name:ISROFF, REGINA S (RD, LD, CD)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:S
Last Name:ISROFF
Suffix:
Gender:F
Credentials:RD, LD, CD
Other - Prefix:MRS
Other - First Name:GINA
Other - Middle Name:S
Other - Last Name:ISROFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, LD, CD
Mailing Address - Street 1:2202 CHEROKEE CIR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2284
Mailing Address - Country:US
Mailing Address - Phone:219-531-4966
Mailing Address - Fax:219-531-4965
Practice Address - Street 1:2202 CHEROKEE CIR
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2284
Practice Address - Country:US
Practice Address - Phone:219-531-4966
Practice Address - Fax:219-531-4965
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37001276133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric