Provider Demographics
NPI:1518388040
Name:KLEIN, JENNIFER JOY (RD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JOY
Last Name:KLEIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:JOY
Other - Last Name:TAMURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8718 LEONA AVE
Mailing Address - Street 2:
Mailing Address - City:LEONA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93551-7406
Mailing Address - Country:US
Mailing Address - Phone:661-622-7049
Mailing Address - Fax:661-622-7049
Practice Address - Street 1:8718 LEONA AVE
Practice Address - Street 2:
Practice Address - City:LEONA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93551-7406
Practice Address - Country:US
Practice Address - Phone:661-622-7049
Practice Address - Fax:661-622-7049
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-31
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
897603133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education