Provider Demographics
NPI:1356540439
Name:DADA, JANICE H (MPH, RD, CDE)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:H
Last Name:DADA
Suffix:
Gender:F
Credentials:MPH, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 QUAIL ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2701
Mailing Address - Country:US
Mailing Address - Phone:949-478-2288
Mailing Address - Fax:949-209-1860
Practice Address - Street 1:1100 QUAIL ST
Practice Address - Street 2:SUITE 111
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2701
Practice Address - Country:US
Practice Address - Phone:949-478-2288
Practice Address - Fax:949-209-1860
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2017-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP579AMedicare PIN