Provider Demographics
NPI:1366111429
Name:ROCK, KRIS EILEEN-HAYN (RDN)
Entity type:Individual
Prefix:
First Name:KRIS
Middle Name:EILEEN-HAYN
Last Name:ROCK
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:KRIS
Other - Middle Name:EILEEN
Other - Last Name:HAYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:28749 STARTREE LANE
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91390
Mailing Address - Country:US
Mailing Address - Phone:818-419-7535
Mailing Address - Fax:
Practice Address - Street 1:23861 MCBEAN PKWY
Practice Address - Street 2:SUITE E11
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-2077
Practice Address - Country:US
Practice Address - Phone:661-222-7370
Practice Address - Fax:661-222-7374
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA881776133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered