Provider Demographics
NPI:1750893004
Name:VANDERPOOL, REY ARLEN
Entity type:Individual
Prefix:
First Name:REY
Middle Name:ARLEN
Last Name:VANDERPOOL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 MOUNT AUBURN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4876
Mailing Address - Country:US
Mailing Address - Phone:339-545-1036
Mailing Address - Fax:617-716-5571
Practice Address - Street 1:158 MOUNT AUBURN ST STE 1
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4876
Practice Address - Country:US
Practice Address - Phone:339-545-1036
Practice Address - Fax:617-716-5571
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-26
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4405133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered