Provider Demographics
NPI:1215230073
Name:FARRELL, THERESE MARIE (MS, RD, CDE)
Entity type:Individual
Prefix:MRS
First Name:THERESE
Middle Name:MARIE
Last Name:FARRELL
Suffix:
Gender:F
Credentials:MS, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3152 WHITE CEDAR PL
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-4903
Mailing Address - Country:US
Mailing Address - Phone:818-261-8091
Mailing Address - Fax:
Practice Address - Street 1:3152 WHITE CEDAR PL
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-4903
Practice Address - Country:US
Practice Address - Phone:818-261-8091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
809704133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic