Provider Demographics
NPI:1316951445
Name:PETERS, JEANNE (RD)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:PETERS
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 1:1707 VIA EL PRADO
Mailing Address - Street 2:SUITE 202
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5732
Mailing Address - Country:US
Mailing Address - Phone:310-792-7830
Mailing Address - Fax:310-792-7840
Practice Address - Street 1:1707 VIA EL PRADO
Practice Address - Street 2:SUITE 202
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5732
Practice Address - Country:US
Practice Address - Phone:310-792-7830
Practice Address - Fax:310-792-7840
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA537020133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic