Provider Demographics
NPI:1104495431
Name:TEMECULA DIETITIANS, INC.
Entity type:Organization
Organization Name:TEMECULA DIETITIANS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:TIANNA
Authorized Official - Middle Name:NOELLE
Authorized Official - Last Name:NILSEN
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:760-716-1274
Mailing Address - Street 1:29970 TECHNOLOGY DR STE 118
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2647
Mailing Address - Country:US
Mailing Address - Phone:951-365-7193
Mailing Address - Fax:
Practice Address - Street 1:29970 TECHNOLOGY DR STE 118
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2647
Practice Address - Country:US
Practice Address - Phone:760-716-1274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-21
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty