Provider Demographics
NPI:1518358548
Name:MILLEN, JODIE (RDN)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:MILLEN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E NAPLES CT
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6821
Mailing Address - Country:US
Mailing Address - Phone:619-205-1102
Mailing Address - Fax:619-205-1323
Practice Address - Street 1:700 E NAPLES CT
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6821
Practice Address - Country:US
Practice Address - Phone:619-205-1102
Practice Address - Fax:619-205-1323
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA834212133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered