Provider Demographics
NPI:1811234131
Name:VAN HILL, KELLY CRISTEN (RD)
Entity Type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:CRISTEN
Last Name:VAN HILL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:CRISTEN
Other - Last Name:VANHILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:6861 VIA MEDIA
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4118
Mailing Address - Country:US
Mailing Address - Phone:714-296-0645
Mailing Address - Fax:
Practice Address - Street 1:6861 VIA MEDIA
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4118
Practice Address - Country:US
Practice Address - Phone:714-296-0645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1056593133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered