Provider Demographics
NPI:1851813398
Name:CHRISTENSEN, ANGELA (RDN, CDCES)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:
Credentials:RDN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3870 LA SIERRA AVE # 1141
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3528
Mailing Address - Country:US
Mailing Address - Phone:951-394-1720
Mailing Address - Fax:
Practice Address - Street 1:21315 ONAKNOLL DR
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-9565
Practice Address - Country:US
Practice Address - Phone:714-686-2551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-15
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA869817133V00000X, 136A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No136A00000XDietary & Nutritional Service ProvidersDietetic Technician, RegisteredGroup - Single Specialty