Healthcare Provider Details

I. General information

NPI: 1144954090
Provider Name (Legal Business Name): CHERRY J ZHUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 RINDGE LN
REDONDO BEACH CA
90278-4312
US

IV. Provider business mailing address

1507 RINDGE LN
REDONDO BEACH CA
90278-4312
US

V. Phone/Fax

Practice location:
  • Phone: 951-231-0282
  • Fax:
Mailing address:
  • Phone: 951-231-0282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number962890
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: