Healthcare Provider Details

I. General information

NPI: 1295300622
Provider Name (Legal Business Name): HEATHER MICHELLE HUANG MPH, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 05/27/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6710 LOCKLENNA LN
RANCHO PALOS VERDES CA
90275-4627
US

IV. Provider business mailing address

6710 LOCKLENNA LN
RANCHO PALOS VERDES CA
90275-4627
US

V. Phone/Fax

Practice location:
  • Phone: 310-408-1400
  • Fax:
Mailing address:
  • Phone: 310-408-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86130750
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: