Provider Demographics
NPI:1912635368
Name:KONEGNI, ANGELA MEGHAN (MS, RD, CSR)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MEGHAN
Last Name:KONEGNI
Suffix:
Gender:F
Credentials:MS, RD, CSR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32919 FAIRMONT LN
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-6283
Mailing Address - Country:US
Mailing Address - Phone:925-818-9399
Mailing Address - Fax:
Practice Address - Street 1:32919 FAIRMONT LN
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-6283
Practice Address - Country:US
Practice Address - Phone:925-818-9399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1102808133VN1005X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal