Healthcare Provider Details

I. General information

NPI: 1528946076
Provider Name (Legal Business Name): CHARITYN ROXANNA FERNANDEZ MS, RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 TAMARINDO WAY
CHULA VISTA CA
91911-5108
US

IV. Provider business mailing address

54 TAMARINDO WAY
CHULA VISTA CA
91911-5108
US

V. Phone/Fax

Practice location:
  • Phone: 619-483-7897
  • Fax:
Mailing address:
  • Phone: 619-483-7897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1101X
TaxonomyGerontological Nutrition Registered Dietitian
License Number86095680
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number86095680
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86095680
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: