Provider Demographics
NPI:1982426425
Name:MARFLEET, JAMES BARRY (CNC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:BARRY
Last Name:MARFLEET
Suffix:
Gender:M
Credentials:CNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15151 DARNELL DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-5504
Mailing Address - Country:US
Mailing Address - Phone:951-290-2960
Mailing Address - Fax:
Practice Address - Street 1:15151 DARNELL DR
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-5504
Practice Address - Country:US
Practice Address - Phone:951-290-2960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20M614804133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist