Provider Demographics
NPI:1265042196
Name:ROS, NANETTE LEE (RDN)
Entity Type:Individual
Prefix:
First Name:NANETTE
Middle Name:LEE
Last Name:ROS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5199 REVERE ST APT 4
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2413
Mailing Address - Country:US
Mailing Address - Phone:626-434-5696
Mailing Address - Fax:
Practice Address - Street 1:5199 REVERE ST APT 4
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2413
Practice Address - Country:US
Practice Address - Phone:626-434-5696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered