Provider Demographics
NPI:1851908321
Name:MCGEOWN, SELYNA BELLE (RD, CDCES)
Entity Type:Individual
Prefix:
First Name:SELYNA
Middle Name:BELLE
Last Name:MCGEOWN
Suffix:
Gender:F
Credentials:RD, CDCES
Other - Prefix:
Other - First Name:SELYNA
Other - Middle Name:BELLE
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD,CDCES
Mailing Address - Street 1:2212 E 4TH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3873
Mailing Address - Country:US
Mailing Address - Phone:714-628-3242
Mailing Address - Fax:
Practice Address - Street 1:2212 E 4TH ST STE 301
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3873
Practice Address - Country:US
Practice Address - Phone:714-628-3242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86116207133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered