Individual
JAQUELINE VIVIAN PEREZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
4338 DAWES ST, SAN DIEGO, CA 92109-4103
(714) 928-8033
Mailing address
4338 DAWES ST, SAN DIEGO, CA 92109-4103
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86050196
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86050196
CDR
CA
Enumeration date
10/18/2018
Last updated
10/18/2018
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