Healthcare Provider Details

I. General information

NPI: 1366338063
Provider Name (Legal Business Name): SUZANNE ELIZONDO RDN, NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 HILLVIEW AVE
STATE COLLEGE PA
16801-7060
US

IV. Provider business mailing address

149 HILLVIEW AVE
STATE COLLEGE PA
16801-7060
US

V. Phone/Fax

Practice location:
  • Phone: 310-936-7304
  • Fax:
Mailing address:
  • Phone: 310-936-7304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3294700
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number896055
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: