Healthcare Provider Details

I. General information

NPI: 1154839801
Provider Name (Legal Business Name): TVEEN PAULINE VERANO MPH, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 01/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E COMMERCIAL ST
SAN DIMAS CA
91773-5001
US

IV. Provider business mailing address

130 E COMMERCIAL ST
SAN DIMAS CA
91773-5001
US

V. Phone/Fax

Practice location:
  • Phone: 626-419-5294
  • Fax:
Mailing address:
  • Phone: 626-419-5294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1069620
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number1069620
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number1069620
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1069620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: