Provider Demographics
NPI:1942827167
Name:DENTON, GUY D JR (RD)
Entity Type:Individual
Prefix:MR
First Name:GUY
Middle Name:D
Last Name:DENTON
Suffix:JR
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1739 N STANTON PL APT 7
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-7917
Mailing Address - Country:US
Mailing Address - Phone:310-926-5828
Mailing Address - Fax:
Practice Address - Street 1:1739 N STANTON PL APT 7
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-7917
Practice Address - Country:US
Practice Address - Phone:310-926-5828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86081613133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered