Provider Demographics
NPI:1023444080
Name:PARKS, KRYSTYN (RD)
Entity type:Individual
Prefix:
First Name:KRYSTYN
Middle Name:
Last Name:PARKS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KRYSTYN
Other - Middle Name:
Other - Last Name:LANDRUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13211 MYFORD RD
Mailing Address - Street 2:1332
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-9153
Mailing Address - Country:US
Mailing Address - Phone:925-699-4453
Mailing Address - Fax:
Practice Address - Street 1:3440 E LA PALMA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-2020
Practice Address - Country:US
Practice Address - Phone:714-644-6750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1001216133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered