Provider Demographics
NPI:1427475896
Name:ALLSUP, LORETTA (CNC)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:ALLSUP
Suffix:
Gender:F
Credentials:CNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4503 RIGEL CT
Mailing Address - Street 2:
Mailing Address - City:SHINGLE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95682-5011
Mailing Address - Country:US
Mailing Address - Phone:408-966-9424
Mailing Address - Fax:916-799-2382
Practice Address - Street 1:12401 FOLSOM BLVD
Practice Address - Street 2:STE 306
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95742-6416
Practice Address - Country:US
Practice Address - Phone:408-966-9424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education