Healthcare Provider Details

I. General information

NPI: 1215230073
Provider Name (Legal Business Name): THERESE MARIE FARRELL MS, RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2010
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3152 WHITE CEDAR PL
THOUSAND OAKS CA
91362-4903
US

IV. Provider business mailing address

3152 WHITE CEDAR PL
THOUSAND OAKS CA
91362-4903
US

V. Phone/Fax

Practice location:
  • Phone: 818-261-8091
  • Fax:
Mailing address:
  • Phone: 818-261-8091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number809704
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: