Provider Demographics
NPI:1760661300
Name:GINES, DEON JAYE
Entity Type:Individual
Prefix:DR
First Name:DEON
Middle Name:JAYE
Last Name:GINES
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:DEON
Other - Middle Name:JAYE
Other - Last Name:GINES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD CD PHD CNSD
Mailing Address - Street 1:1883 S 900 E
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-2341
Mailing Address - Country:US
Mailing Address - Phone:801-949-9394
Mailing Address - Fax:801-350-4072
Practice Address - Street 1:1883 S 900 E
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-2341
Practice Address - Country:US
Practice Address - Phone:801-949-9394
Practice Address - Fax:801-350-4072
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X, 133VN1005X
UT5076321-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal