Healthcare Provider Details

I. General information

NPI: 1356513865
Provider Name (Legal Business Name): WAIKI VICKY CORA RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WAIKI VICKY LEUNG

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8270 WOODLAND CENTER BLVD
TAMPA FL
33614-2401
US

IV. Provider business mailing address

317 6TH AVE STE 400
DES MOINES IA
50309-4108
US

V. Phone/Fax

Practice location:
  • Phone: 305-449-9219
  • Fax: 515-864-0259
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND10389
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD1583
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: