Provider Demographics
NPI:1376151563
Name:CHANEY, JILLIAN S (RDN)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:S
Last Name:CHANEY
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 1:94 VIA ONDA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-5688
Mailing Address - Country:US
Mailing Address - Phone:412-901-4458
Mailing Address - Fax:
Practice Address - Street 1:94 VIA ONDA
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-5688
Practice Address - Country:US
Practice Address - Phone:412-901-4458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86106331133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered