NPI 1336876945 · live from the CMS NPI Registry
Sophia Brooke Daeseleer, RD
Dietitian, Registered in Moreno, CA. National Provider Identifier 1336876945, active.
NPI record
| NPI | 1336876945 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered 133V00000X |
| Practice location | 27300 Iris Ave, Moreno, CA 91786 |
| Practice phone | 951-251-6000 |
| Mailing address | Po Box 1283, Kekaha, HI 96752 |
| Enumerated | August 3, 2022 |
| Last updated | August 4, 2022 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered primary | 133V00000X | 86294851 (CA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.