Healthcare Provider Details

I. General information

NPI: 1588304869
Provider Name (Legal Business Name): GRETCHEN ELIZABETH TSENG FNTP, CFNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6518 N FAIRBORN AVE
MERIDIAN ID
83646-4988
US

IV. Provider business mailing address

6518 N FAIRBORN AVE
MERIDIAN ID
83646-4988
US

V. Phone/Fax

Practice location:
  • Phone: 949-280-5025
  • Fax:
Mailing address:
  • Phone: 949-280-5025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: