Provider Demographics
NPI:1720855034
Name:MICHELLI, TERRIAN (RD)
Entity Type:Individual
Prefix:MRS
First Name:TERRIAN
Middle Name:
Last Name:MICHELLI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6109 NANCY DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3823
Mailing Address - Country:US
Mailing Address - Phone:225-733-3735
Mailing Address - Fax:
Practice Address - Street 1:6109 NANCY DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3823
Practice Address - Country:US
Practice Address - Phone:225-733-3735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86291465133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered