Provider Demographics
NPI:1508479809
Name:NOVAL, JERL JEAN (RDN)
Entity Type:Individual
Prefix:
First Name:JERL JEAN
Middle Name:
Last Name:NOVAL
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:JEJE
Other - Middle Name:
Other - Last Name:NOVAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDN
Mailing Address - Street 1:731 MCAULIFFE CT
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-5480
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1255 W COLTON AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2861
Practice Address - Country:US
Practice Address - Phone:909-363-6533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA812894133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered