Provider Demographics
NPI:1316621212
Name:FLYNN, ROSEMARY TARA (MS)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:TARA
Last Name:FLYNN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2327 VISTA HUERTA
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-4038
Mailing Address - Country:US
Mailing Address - Phone:949-200-9181
Mailing Address - Fax:
Practice Address - Street 1:2327 VISTA HUERTA
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-4038
Practice Address - Country:US
Practice Address - Phone:949-200-9181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist