Healthcare Provider Details

I. General information

NPI: 1326661877
Provider Name (Legal Business Name): KRISTINA MARIE LOUISE LOREY REGISTERED DIETICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTINA MARIA LOUISE LOREY REGISTERED DIETICIAN

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CALIFORNIA DRIVE
YOUNTVILLE CA
94599-1412
US

IV. Provider business mailing address

100 CALIFORNIA DRIVE, 3E, ROOM 13
YOUNTVILLE CA
94599-1412
US

V. Phone/Fax

Practice location:
  • Phone: 707-944-4506
  • Fax: 707-944-5052
Mailing address:
  • Phone: 707-944-4506
  • Fax: 707-944-5052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86106669
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: