Provider Demographics
NPI:1467225391
Name:DEWOLF, LAUREN (MS, RD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:DEWOLF
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 1:5745 FRIARS RD UNIT 127
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-1831
Mailing Address - Country:US
Mailing Address - Phone:858-822-8037
Mailing Address - Fax:
Practice Address - Street 1:5651 COPLEY DR STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-7903
Practice Address - Country:US
Practice Address - Phone:858-262-6109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered