Provider Demographics
NPI:1427205129
Name:KNOTEN, NATASHA DENEEN (RD)
Entity Type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:DENEEN
Last Name:KNOTEN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9510 OLIVE ST
Mailing Address - Street 2:APT 6
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-5715
Mailing Address - Country:US
Mailing Address - Phone:909-429-1066
Mailing Address - Fax:
Practice Address - Street 1:9510 OLIVE ST
Practice Address - Street 2:APT 6
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-2425
Practice Address - Country:US
Practice Address - Phone:909-429-1066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA910523133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered