Healthcare Provider Details

I. General information

NPI: 1538282983
Provider Name (Legal Business Name): MARY SEIERSEN RDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 KATELLA AVE STE 275
LOS ALAMITOS CA
90720-3377
US

IV. Provider business mailing address

15464 GOLDENWEST ST
WESTMINSTER CA
92683-6149
US

V. Phone/Fax

Practice location:
  • Phone: 562-296-5528
  • Fax: 562-296-8506
Mailing address:
  • Phone: 714-891-9008
  • Fax: 714-893-2239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number711000
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: