Healthcare Provider Details

I. General information

NPI: 1265049191
Provider Name (Legal Business Name): CHANTI RANDOLPH F.N.T.P
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6677 SANTA MONICA BLVD APT 1307
LOS ANGELES CA
90038-1392
US

IV. Provider business mailing address

6677 SANTA MONICA BLVD APT 1307
LOS ANGELES CA
90038-1392
US

V. Phone/Fax

Practice location:
  • Phone: 314-882-5568
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: