Healthcare Provider Details

I. General information

NPI: 1659304277
Provider Name (Legal Business Name): TZU-CHING WU R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 DALE RD
MODESTO CA
95356-9718
US

IV. Provider business mailing address

2813 TEMESCAL DR
MODESTO CA
95355-8613
US

V. Phone/Fax

Practice location:
  • Phone: 209-735-5086
  • Fax:
Mailing address:
  • Phone: 209-242-6337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number940840
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: