Provider Demographics
NPI:1417608779
Name:ANGER-BETZ, JASMINE EVE (RD)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:EVE
Last Name:ANGER-BETZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:EVE
Other - Last Name:ANGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:35337 THORPE TRL
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-6240
Mailing Address - Country:US
Mailing Address - Phone:909-557-0580
Mailing Address - Fax:
Practice Address - Street 1:27300 IRIS AVE
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-4802
Practice Address - Country:US
Practice Address - Phone:951-251-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86072507133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered