Provider Demographics
NPI:1154905727
Name:GAFFEN, DANIELLE ROSE (MS, RDN, LD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ROSE
Last Name:GAFFEN
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4116 MORNING STAR CT
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-7228
Mailing Address - Country:US
Mailing Address - Phone:619-985-5656
Mailing Address - Fax:
Practice Address - Street 1:4116 MORNING STAR CT
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-7228
Practice Address - Country:US
Practice Address - Phone:619-985-5656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86093953133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86093953OtherCOMMISSION ON DIETETIC REGISTRATION