Provider Demographics
NPI:1558101816
Name:ROSTON, STEPHANIE KAY (RDN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KAY
Last Name:ROSTON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29970 TECHNOLOGY DR STE 105D
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2646
Mailing Address - Country:US
Mailing Address - Phone:951-346-0064
Mailing Address - Fax:
Practice Address - Street 1:29970 TECHNOLOGY DR STE 105D
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2646
Practice Address - Country:US
Practice Address - Phone:951-346-0064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-25
Last Update Date:2024-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA886294133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist