Healthcare Provider Details

I. General information

NPI: 1922315076
Provider Name (Legal Business Name): PEGGY T HUTZEZON RD, CNSC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2010
Last Update Date: 09/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1748 260TH ST
LOMITA CA
90717-0216
US

IV. Provider business mailing address

PO BOX 216
LOMITA CA
90717-0216
US

V. Phone/Fax

Practice location:
  • Phone: 310-530-2828
  • Fax: 310-530-5606
Mailing address:
  • Phone: 310-530-2828
  • Fax: 310-530-5606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number887760
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: