Healthcare Provider Details

I. General information

NPI: 1871332619
Provider Name (Legal Business Name): JIALE REN RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 W SHAW AVE STE 106
FRESNO CA
93711-3412
US

IV. Provider business mailing address

2350 W SHAW AVE STE 106
FRESNO CA
93711-3412
US

V. Phone/Fax

Practice location:
  • Phone: 559-451-0460
  • Fax:
Mailing address:
  • Phone: 559-451-0460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86314375
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: