Provider Demographics
NPI:1235733254
Name:DEAN, CLAIRE (MPH, RD)
Entity Type:Individual
Prefix:MRS
First Name:CLAIRE
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4295 GESNER ST STE 3A2
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-6646
Mailing Address - Country:US
Mailing Address - Phone:619-289-8131
Mailing Address - Fax:
Practice Address - Street 1:4295 GESNER ST STE 3A2
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6646
Practice Address - Country:US
Practice Address - Phone:619-289-8131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86023918133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered