Provider Demographics
NPI:1578591392
Name:MEYLE, JESSICA L (RD)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:L
Last Name:MEYLE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:440 N BARRANCA AVE # 4623
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1722
Mailing Address - Country:US
Mailing Address - Phone:909-897-3002
Mailing Address - Fax:
Practice Address - Street 1:109 ZERMAT DR # 1398
Practice Address - Street 2:
Practice Address - City:CRESTLINE
Practice Address - State:CA
Practice Address - Zip Code:92325-9391
Practice Address - Country:US
Practice Address - Phone:909-897-3002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2024-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003282133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered