Provider Demographics
NPI:1699019042
Name:REZENDE, LAUREN (MPH, RD)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:REZENDE
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4977 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-5475
Mailing Address - Country:US
Mailing Address - Phone:619-971-0384
Mailing Address - Fax:
Practice Address - Street 1:4977 WOOD ST
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-5475
Practice Address - Country:US
Practice Address - Phone:619-971-0384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-23
Last Update Date:2012-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA898906133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered