Healthcare Provider Details

I. General information

NPI: 1710136288
Provider Name (Legal Business Name): MRS. STACIE NACHI TSUKADA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACIE NACHI HOSOKAWA RD, CNSD

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E 7TH ST C/O NUTRITION & FOOD SERVICES
LONG BEACH CA
90822-5201
US

IV. Provider business mailing address

5901 E 7TH ST C/O NUTRITION & FOOD SERVICES
LONG BEACH CA
90822-5201
US

V. Phone/Fax

Practice location:
  • Phone: 562-826-8000
  • Fax: 562-826-5947
Mailing address:
  • Phone: 562-826-8000
  • Fax: 562-826-5947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: