Provider Demographics
NPI:1063299162
Name:HELMUTH, THERESA (RDN, CSR)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:HELMUTH
Suffix:
Gender:F
Credentials:RDN, CSR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31976 LAZY GLEN LN
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-3217
Mailing Address - Country:US
Mailing Address - Phone:949-636-4907
Mailing Address - Fax:
Practice Address - Street 1:31976 LAZY GLEN LN
Practice Address - Street 2:
Practice Address - City:TRABUCO CANYON
Practice Address - State:CA
Practice Address - Zip Code:92679-3217
Practice Address - Country:US
Practice Address - Phone:949-636-4907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86058814133VN1005X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal