Provider Demographics
NPI:1336011717
Name:MOHAMED, DANIELLE COLLEEN (MS, RDN, LDN)
Entity type:Individual
Prefix:MISS
First Name:DANIELLE
Middle Name:COLLEEN
Last Name:MOHAMED
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2156 VIA ROBLES
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6311
Mailing Address - Country:US
Mailing Address - Phone:760-996-4717
Mailing Address - Fax:888-549-9864
Practice Address - Street 1:4231 US HIGHWAY 86 STE 1
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-9648
Practice Address - Country:US
Practice Address - Phone:760-996-4717
Practice Address - Fax:888-549-9864
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86172079133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered