Provider Demographics
NPI:1851894679
Name:KIRESICH, EMILY JOY (RD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JOY
Last Name:KIRESICH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:JOY
Other - Last Name:HAYNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:5936 BRIERCREST AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-1016
Mailing Address - Country:US
Mailing Address - Phone:951-675-0064
Mailing Address - Fax:
Practice Address - Street 1:5936 BRIERCREST AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713-1016
Practice Address - Country:US
Practice Address - Phone:951-675-0064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-18
Last Update Date:2018-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered