Provider Demographics
NPI:1245798164
Name:DUPUIS, MELISSA YUEN-TING (MS, RD, CSR)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:YUEN-TING
Last Name:DUPUIS
Suffix:
Gender:F
Credentials:MS, RD, CSR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 FIREBRAND LN
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5674
Mailing Address - Country:US
Mailing Address - Phone:209-815-8205
Mailing Address - Fax:
Practice Address - Street 1:3071 GOLD CANAL DR
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-6129
Practice Address - Country:US
Practice Address - Phone:916-638-8429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-10
Last Update Date:2019-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86031120133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered