Provider Demographics
NPI:1124648050
Name:PREZIOSO, KIMBERLY (MS, RDN, CLE)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:PREZIOSO
Suffix:
Gender:F
Credentials:MS, RDN, CLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27305 LIVE OAK RD UNIT A89
Mailing Address - Street 2:
Mailing Address - City:CASTAIC
Mailing Address - State:CA
Mailing Address - Zip Code:91384-4520
Mailing Address - Country:US
Mailing Address - Phone:818-399-9115
Mailing Address - Fax:
Practice Address - Street 1:13803 FOOTHILL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-3013
Practice Address - Country:US
Practice Address - Phone:818-898-1388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management