Provider Demographics
NPI:1811484348
Name:BELL, KRISTEN RENEE (RD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:RENEE
Last Name:BELL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:RENEE
Other - Last Name:REAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:3325 CASTLE HEIGHTS AVE APT 203
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-2767
Mailing Address - Country:US
Mailing Address - Phone:310-525-9570
Mailing Address - Fax:
Practice Address - Street 1:1740 STEWART ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-4022
Practice Address - Country:US
Practice Address - Phone:310-393-4647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA963755133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty