Provider Demographics
NPI:1578709069
Name:RICHARDSON, KRISTY L
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:L
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 LAURENT
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-8306
Mailing Address - Country:US
Mailing Address - Phone:949-933-6788
Mailing Address - Fax:
Practice Address - Street 1:18 TECHNOLOGY DR
Practice Address - Street 2:SUITE 167
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2308
Practice Address - Country:US
Practice Address - Phone:949-933-6788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education