Provider Demographics
NPI:1396182333
Name:PENHA, JANINE ELIZABETH (RD, CDE)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:ELIZABETH
Last Name:PENHA
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10645 CALLE MAR DE MARIPOSA APT 6113
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-8718
Mailing Address - Country:US
Mailing Address - Phone:707-337-2163
Mailing Address - Fax:
Practice Address - Street 1:2550 SAMARITAN DR
Practice Address - Street 2:SUITE A
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4104
Practice Address - Country:US
Practice Address - Phone:707-337-2163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21220047133V00000X
FL910306133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered