Healthcare Provider Details

I. General information

NPI: 1164241279
Provider Name (Legal Business Name): RIZZA MAGBUHAT EDRADAN CSR, RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RIZZA MARIE TUVIDA MAGBUHAT RIZZA MARIE MAGBUHAT

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 RIVELLA DR
WAKE FOREST NC
27587-3639
US

IV. Provider business mailing address

337 RIVELLA DR
WAKE FOREST NC
27587-3639
US

V. Phone/Fax

Practice location:
  • Phone: 415-867-4422
  • Fax:
Mailing address:
  • Phone: 415-867-4422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL005028
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND1244
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86036227
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number86036227
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: