is a Nutrition, Renal in , . practices all healthcare services and medical treatments related to Nutrition, Renal. The NPI Number for is 1497965479. The last update date is .
's current location address is , , . You can contact this provider via phone number . The mailing address for is , , . To know further, please read the information below!
Provider Profile Detail
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| Address | , , |
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| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1497965479 |
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| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
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| City | |
| State | () |
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Provider's Primary Taxonomy Detail
| Speciality | Nutrition, Renal |
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| Taxonomy | 133Vn1005X |
| Licence No | 864322 |
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Definition: An individual who is a Board Certified Specialist in Renal Nutrition and works directly with adult and/or pediatric patients with acute kidney injury, chronic kidney disease (CKD) stages 1-5, or receiving renal replacement therapies (dialysis/transpl |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 864322 | CA | LICENSE |
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