Provider Demographics
NPI:1194400820
Name:BABAEI, ROJA (CNS, LDN, CN, LN)
Entity type:Individual
Prefix:
First Name:ROJA
Middle Name:
Last Name:BABAEI
Suffix:
Gender:
Credentials:CNS, LDN, CN, LN
Other - Prefix:MRS
Other - First Name:ROJA
Other - Middle Name:
Other - Last Name:BABAEI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNS, LDN, CN, LN
Mailing Address - Street 1:16855 RALPHS RANCH RD APT 308
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-7843
Mailing Address - Country:US
Mailing Address - Phone:301-755-4382
Mailing Address - Fax:
Practice Address - Street 1:544 MEADOWOOD ST
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3824
Practice Address - Country:US
Practice Address - Phone:301-755-4382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU61444778133N00000X
NMNDP-2024-0160133N00000X
MDDX6460133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist