Provider Demographics
NPI:1285756213
Name:REYNOLDS, BETTY JOAN PEARN (RD)
Entity type:Individual
Prefix:MRS
First Name:BETTY JOAN
Middle Name:PEARN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2507 LA COSTA AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-1407
Mailing Address - Country:US
Mailing Address - Phone:619-482-8719
Mailing Address - Fax:
Practice Address - Street 1:2507 LA COSTA AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-1407
Practice Address - Country:US
Practice Address - Phone:619-482-8719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA246576133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered