Provider Demographics
NPI:1871627224
Name:DEUTSCH, JEROME (MS, LN)
Entity type:Individual
Prefix:MR
First Name:JEROME
Middle Name:
Last Name:DEUTSCH
Suffix:
Gender:M
Credentials:MS, LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 F CALLE OJO FELIZ
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505
Mailing Address - Country:US
Mailing Address - Phone:505-955-0922
Mailing Address - Fax:505-954-4234
Practice Address - Street 1:147 F CALLE OJO FELIZ
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505
Practice Address - Country:US
Practice Address - Phone:505-955-0922
Practice Address - Fax:505-954-4234
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM538133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist