Provider Demographics
NPI:1760717490
Name:SLATON, JESSICA ANNE (RD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:SLATON
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 1:5937 E PACIFIC COAST HWY
Mailing Address - Street 2:#6
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-4981
Mailing Address - Country:US
Mailing Address - Phone:951-809-8682
Mailing Address - Fax:
Practice Address - Street 1:5937 E PACIFIC COAST HWY
Practice Address - Street 2:#6
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4981
Practice Address - Country:US
Practice Address - Phone:951-809-8682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1020545133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered