Healthcare Provider Details

I. General information

NPI: 1891047940
Provider Name (Legal Business Name): JILL MICHELLE GREER MS, RD, CNSC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JILL MICHELLE RAND MS, RD, CNSC

II. Dates (important events)

Enumeration Date: 10/12/2012
Last Update Date: 10/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5776 RUFFIN RD
SAN DIEGO CA
92123-1013
US

IV. Provider business mailing address

32377 ALPINE CT
TEMECULA CA
92592-4191
US

V. Phone/Fax

Practice location:
  • Phone: 858-292-1144
  • Fax:
Mailing address:
  • Phone: 562-810-2830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number888122
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: