Provider Demographics
NPI:1750837431
Name:PEREZ, VANESSA PATRICIA (RD)
Entity Type:Individual
Prefix:MISS
First Name:VANESSA
Middle Name:PATRICIA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 PINE ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801-4931
Mailing Address - Country:US
Mailing Address - Phone:973-885-5763
Mailing Address - Fax:
Practice Address - Street 1:16 PINE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-4931
Practice Address - Country:US
Practice Address - Phone:973-885-5763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1062378133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered