Provider Demographics
NPI:1831866896
Name:TOURVILLE, PAULETTE ANGELA (RDN)
Entity type:Individual
Prefix:
First Name:PAULETTE
Middle Name:ANGELA
Last Name:TOURVILLE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9240 OLD REDWOOD HWY UNIT 200
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-9349
Mailing Address - Country:US
Mailing Address - Phone:707-837-3710
Mailing Address - Fax:
Practice Address - Street 1:9240 OLD REDWOOD HWY UNIT 200
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-9349
Practice Address - Country:US
Practice Address - Phone:707-837-3710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86047907133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered