Provider Demographics
NPI:1225145576
Name:NOGUERA, ERNESTINE V (RD)
Entity Type:Individual
Prefix:MS
First Name:ERNESTINE
Middle Name:V
Last Name:NOGUERA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:V
Other - Last Name:NOGUERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:4457 NOROCCO CIR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-2104
Mailing Address - Country:US
Mailing Address - Phone:510-797-5009
Mailing Address - Fax:
Practice Address - Street 1:4457 NOROCCO CIR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94555-2104
Practice Address - Country:US
Practice Address - Phone:510-797-5009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
R405742133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered