Healthcare Provider Details

I. General information

NPI: 1952910739
Provider Name (Legal Business Name): MOLLIE FERGUSON RD, LDN, IFMCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46-036 KAMEHAMEHA HWY P.O. BOX #1505
KANEOHE HI
96744
US

IV. Provider business mailing address

46-036 KAMEHAMEHA HWY P.O. BOX #1505
KANEOHE HI
96744
US

V. Phone/Fax

Practice location:
  • Phone: 626-470-7711
  • Fax:
Mailing address:
  • Phone: 626-470-7711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: