Provider Demographics
NPI:1821841297
Name:HANSEN, YVETTE LYDIA (RDN)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:LYDIA
Last Name:HANSEN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33657 EMERSON WAY UNIT A
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-5356
Mailing Address - Country:US
Mailing Address - Phone:951-805-9313
Mailing Address - Fax:
Practice Address - Street 1:33657 EMERSON WAY UNIT A
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-5356
Practice Address - Country:US
Practice Address - Phone:951-805-9313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86118469133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered