Healthcare Provider Details

I. General information

NPI: 1790620797
Provider Name (Legal Business Name): ANASTISCIA LANG RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 TAHOE BLVD STE 802-128
INCLINE VILLAGE NV
89451-9451
US

IV. Provider business mailing address

930 TAHOE BLVD STE 802-128
INCLINE VILLAGE NV
89451-9451
US

V. Phone/Fax

Practice location:
  • Phone: 760-409-3014
  • Fax: 760-409-3014
Mailing address:
  • Phone: 760-409-3014
  • Fax: 760-409-3014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number7961061
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: