Provider Demographics
NPI:1154868859
Name:NESBITT, ROBERT JAMES JR (CTNC, FDN-P)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JAMES
Last Name:NESBITT
Suffix:JR
Gender:M
Credentials:CTNC, FDN-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5666 WHITEWATER ST
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-3736
Mailing Address - Country:US
Mailing Address - Phone:714-777-8306
Mailing Address - Fax:
Practice Address - Street 1:5666 WHITEWATER ST
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887-3736
Practice Address - Country:US
Practice Address - Phone:714-777-8306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAITN-01082016133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist