Provider Demographics
NPI:1700893906
Name:CHEN-MAYNARD, DOROTHY C (PHD, RD)
Entity Type:Individual
Prefix:PROF
First Name:DOROTHY
Middle Name:C
Last Name:CHEN-MAYNARD
Suffix:
Gender:F
Credentials:PHD, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4951 MARIPOSA DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-1432
Mailing Address - Country:US
Mailing Address - Phone:909-537-5340
Mailing Address - Fax:909-537-7037
Practice Address - Street 1:4951 MARIPOSA DR
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-1432
Practice Address - Country:US
Practice Address - Phone:909-537-5340
Practice Address - Fax:909-537-7037
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR591434133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered