Provider Demographics
NPI:1679192629
Name:CORDERO SERRANO, JEFFREY ROYCE (RD, CNSC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ROYCE
Last Name:CORDERO SERRANO
Suffix:
Gender:M
Credentials:RD, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17940 TULSA PL
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-4424
Mailing Address - Country:US
Mailing Address - Phone:818-726-5217
Mailing Address - Fax:
Practice Address - Street 1:17940 TULSA PL
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-4424
Practice Address - Country:US
Practice Address - Phone:818-726-5217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86017391133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered