Provider Demographics
NPI:1265457055
Name:MACANAS, JELITA
Entity Type:Individual
Prefix:
First Name:JELITA
Middle Name:
Last Name:MACANAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11606 REAGAN RD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-8253
Mailing Address - Country:US
Mailing Address - Phone:661-587-8106
Mailing Address - Fax:
Practice Address - Street 1:659 S CENTRAL VALLEY HWY
Practice Address - Street 2:
Practice Address - City:SHAFTER
Practice Address - State:CA
Practice Address - Zip Code:93263-2790
Practice Address - Country:US
Practice Address - Phone:661-459-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA835243133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered