Provider Demographics
NPI:1437465820
Name:D'AMBROSI, JENNIFER (MS, RD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:D'AMBROSI
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 S AVERILL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3915
Mailing Address - Country:US
Mailing Address - Phone:310-702-5041
Mailing Address - Fax:
Practice Address - Street 1:1423 S AVERILL AVE
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3915
Practice Address - Country:US
Practice Address - Phone:310-702-5041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA982328133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered