Provider Demographics
NPI:1649902347
Name:FARIAS, JEREMIAH MICHAEL (RDN)
Entity type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:MICHAEL
Last Name:FARIAS
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2870 N TOWNE AVE APT 61
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2063
Mailing Address - Country:US
Mailing Address - Phone:626-201-8945
Mailing Address - Fax:
Practice Address - Street 1:2870 N TOWNE AVE APT 61
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2063
Practice Address - Country:US
Practice Address - Phone:626-201-8945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management