Provider Demographics
NPI:1194463042
Name:YUAN, JERI (MS, RD)
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:
Last Name:YUAN
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12682 GREENBELT RD
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-3341
Mailing Address - Country:US
Mailing Address - Phone:626-927-8181
Mailing Address - Fax:
Practice Address - Street 1:1901 TOWN AND COUNTRY DR STE 100
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-3611
Practice Address - Country:US
Practice Address - Phone:951-738-0185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86003674133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered