Provider Demographics
NPI:1831663863
Name:KANTOR, CORINNE (DTR, CLT)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:
Last Name:KANTOR
Suffix:
Gender:F
Credentials:DTR, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27758 SANTA MARGARITA PKWY STE 410
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6709
Mailing Address - Country:US
Mailing Address - Phone:949-888-1793
Mailing Address - Fax:
Practice Address - Street 1:55 PASEO PRIMERO
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-3361
Practice Address - Country:US
Practice Address - Phone:949-888-1793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-12
Last Update Date:2019-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered