Provider Demographics
NPI:1437343654
Name:MARINAS-OLIVER, IRENE (RD)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:MARINAS-OLIVER
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 1:12222 BRIANWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-6752
Mailing Address - Country:US
Mailing Address - Phone:951-333-3515
Mailing Address - Fax:951-688-6857
Practice Address - Street 1:12222 BRIANWOOD DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-6752
Practice Address - Country:US
Practice Address - Phone:951-333-3515
Practice Address - Fax:951-688-6857
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA806369133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal