Provider Demographics
NPI:1417651266
Name:PENROSE, CHRISTINE (RDN, MS)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:PENROSE
Suffix:
Gender:F
Credentials:RDN, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 STANISLAUS AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-1147
Mailing Address - Country:US
Mailing Address - Phone:925-699-3002
Mailing Address - Fax:
Practice Address - Street 1:13 STANISLAUS AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004-1147
Practice Address - Country:US
Practice Address - Phone:925-699-3002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86042653133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered