Basic Information
| Provider Information | |||||||||
| NPI: | 1548892128 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDREWS | ||||||||
| FirstName: | JENSINE | ||||||||
| MiddleName: | CASSANDRA | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | RDN, CLEC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 SCRIPPS AISLE | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926124112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7142964689 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 972 GOODRICH BLVD | ||||||||
| Address2: | |||||||||
| City: | COMMERCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900224114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8884999303 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2020 | ||||||||
| LastUpdateDate: | 02/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 86007733 | CA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.