Provider Demographics
NPI:1265970982
Name:CORREIA, DREW (RD)
Entity type:Individual
Prefix:
First Name:DREW
Middle Name:
Last Name:CORREIA
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 1:515 NOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5764
Mailing Address - Country:US
Mailing Address - Phone:909-557-7722
Mailing Address - Fax:
Practice Address - Street 1:515 NOTTINGHAM DR
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5764
Practice Address - Country:US
Practice Address - Phone:909-557-7722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0962611133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered