Provider Demographics
NPI:1891090692
Name:EIMERS, JENNIFER (RD)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:EIMERS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 DONNA WAY
Mailing Address - Street 2:SOBOBA INDIAN HEALTH
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583
Mailing Address - Country:US
Mailing Address - Phone:951-654-0803
Mailing Address - Fax:951-654-5957
Practice Address - Street 1:607 DONNA WAY
Practice Address - Street 2:SOBOBA INDIAN HEALTH
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-5517
Practice Address - Country:US
Practice Address - Phone:951-654-0803
Practice Address - Fax:951-654-5957
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01023076133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered