Provider Demographics
NPI:1568059418
Name:FLAHERTY, JESSICA FRANCES (RD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:FRANCES
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 CALLE TAMEGA
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8611
Mailing Address - Country:US
Mailing Address - Phone:805-304-9162
Mailing Address - Fax:
Practice Address - Street 1:219 CALLE TAMEGA
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-8611
Practice Address - Country:US
Practice Address - Phone:805-304-9162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-27
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered