Healthcare Provider Details

I. General information

NPI: 1477836013
Provider Name (Legal Business Name): DENISE ROLEN HHP, FDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14895 DEL DIABLO LN
SAN DIEGO CA
92129-1520
US

IV. Provider business mailing address

14895 DEL DIABLO LN
SAN DIEGO CA
92129-1520
US

V. Phone/Fax

Practice location:
  • Phone: 858-945-6199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number2004003120
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: