Provider Demographics
NPI:1891047940
Name:GREER, JILL MICHELLE (MS, RD, CNSC)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MICHELLE
Last Name:GREER
Suffix:
Gender:F
Credentials:MS, RD, CNSC
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:MICHELLE
Other - Last Name:RAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, CNSC
Mailing Address - Street 1:32377 ALPINE CT
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-4191
Mailing Address - Country:US
Mailing Address - Phone:562-810-2830
Mailing Address - Fax:
Practice Address - Street 1:5776 RUFFIN RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1013
Practice Address - Country:US
Practice Address - Phone:858-292-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA888122133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric