Provider Demographics
NPI:1811535552
Name:RONNE, DEANNA (RDN CDN LDN)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:RONNE
Suffix:
Gender:F
Credentials:RDN CDN LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3990 MARCASEL AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-4616
Mailing Address - Country:US
Mailing Address - Phone:781-635-4926
Mailing Address - Fax:833-892-0506
Practice Address - Street 1:3990 MARCASEL AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-4616
Practice Address - Country:US
Practice Address - Phone:781-635-4926
Practice Address - Fax:833-892-0506
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-12
Last Update Date:2020-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4692133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered