Healthcare Provider Details

I. General information

NPI: 1477122208
Provider Name (Legal Business Name): LYDIA'S MEDICAL NUTRITION THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 ARBUCKLE WAY
LANCASTER CA
93534-1341
US

IV. Provider business mailing address

1833 ARBUCKLE WAY
LANCASTER CA
93534-1341
US

V. Phone/Fax

Practice location:
  • Phone: 951-902-3334
  • Fax:
Mailing address:
  • Phone: 951-902-3334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: DR. LYDIA SIPHIWE CHOWA
Title or Position: DIETITIAN
Credential: DR.PH, RD, RN
Phone: 951-902-3334