Provider Demographics
NPI:1659711273
Name:PETERS, REMY LEIGH (RD CNSC)
Entity Type:Individual
Prefix:
First Name:REMY
Middle Name:LEIGH
Last Name:PETERS
Suffix:
Gender:F
Credentials:RD CNSC
Other - Prefix:
Other - First Name:REMY
Other - Middle Name:LEIGH
Other - Last Name:HEUSTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD CNSC
Mailing Address - Street 1:5009 WOODMAN AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-1340
Mailing Address - Country:US
Mailing Address - Phone:818-317-7355
Mailing Address - Fax:
Practice Address - Street 1:181 S BUENA VISTA ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4504
Practice Address - Country:US
Practice Address - Phone:818-317-7355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA892740133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered