Provider Demographics
NPI:1801248612
Name:TOVAR, KRISTIE MOORE (MS, RDN)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:MOORE
Last Name:TOVAR
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:KRISTIE
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RDN
Mailing Address - Street 1:27284 VIA MARCIA
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-1539
Mailing Address - Country:US
Mailing Address - Phone:818-731-5352
Mailing Address - Fax:818-925-3728
Practice Address - Street 1:715 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-4262
Practice Address - Country:US
Practice Address - Phone:818-731-5352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86012873133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered