Provider Demographics
NPI:1902108970
Name:HINDS, KELLY DENISE (RD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:DENISE
Last Name:HINDS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9968 HIBERT ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1036
Mailing Address - Country:US
Mailing Address - Phone:858-952-6404
Mailing Address - Fax:619-956-0153
Practice Address - Street 1:9968 HIBERT ST STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1036
Practice Address - Country:US
Practice Address - Phone:858-952-6404
Practice Address - Fax:619-956-0153
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
922818133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered