Healthcare Provider Details

I. General information

NPI: 1205150265
Provider Name (Legal Business Name): SANDY S KHOLGHY RD, RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2010
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12616 LANSDALE CIR
STANTON CA
90680-4125
US

IV. Provider business mailing address

12616 LANSDALE CIR
STANTON CA
90680-4125
US

V. Phone/Fax

Practice location:
  • Phone: 714-837-0362
  • Fax:
Mailing address:
  • Phone: 714-837-0362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86278354
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: