Healthcare Provider Details

I. General information

NPI: 1649313255
Provider Name (Legal Business Name): CANDICE LOVEJOY DREYER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 E CHAPMAN AVE
ORANGE CA
92869-3206
US

IV. Provider business mailing address

2345 NEWPORT BLVD APT. F101
COSTA MESA CA
92627-1575
US

V. Phone/Fax

Practice location:
  • Phone: 714-633-0011
  • Fax:
Mailing address:
  • Phone: 805-801-5535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number933388
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: