Provider Demographics
NPI:1417752239
Name:EMMONS, DANIELLE (RDN)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:EMMONS
Suffix:
Gender:
Credentials:RDN
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:NICOLE
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:28 TEABERRY LN
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-8537
Mailing Address - Country:US
Mailing Address - Phone:310-850-0702
Mailing Address - Fax:
Practice Address - Street 1:28 TEABERRY LN
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-8537
Practice Address - Country:US
Practice Address - Phone:310-850-0702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA864674133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered