Healthcare Provider Details

I. General information

NPI: 1780599209
Provider Name (Legal Business Name): NITA YUZHEN LI RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6343 ROSEMEAD BLVD
SAN GABRIEL CA
91775-1997
US

IV. Provider business mailing address

828 ODONNELL AVE
SAN LEANDRO CA
94577-1387
US

V. Phone/Fax

Practice location:
  • Phone: 510-604-6153
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86210361
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: