Provider Demographics
NPI:1679066997
Name:BALLINTINE, JENNIFER (RDN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BALLINTINE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:BALLINTINE
Other - Last Name:TRANBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2511 NAVARRO DR
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-7660
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2511 NAVARRO DRIVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973
Practice Address - Country:US
Practice Address - Phone:650-868-4712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1065206133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1065206OtherREGISTERED DIETITIAN