Healthcare Provider Details

I. General information

NPI: 1801663562
Provider Name (Legal Business Name): LOSHI VUE RD, LD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 BROOKLYN BLVD SUITE 202
BROOKLYN CENTER MN
55429
US

IV. Provider business mailing address

202 W TRIBELLA CT
SANTA ANA CA
92703-3634
US

V. Phone/Fax

Practice location:
  • Phone: 612-518-6826
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86211821
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number4513
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: