Healthcare Provider Details

I. General information

NPI: 1215112248
Provider Name (Legal Business Name): ANGEL CHI CHI PLANELLS MS, RDN, FAND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8015 SE 28TH ST STE 304
MERCER ISLAND WA
98040-2910
US

IV. Provider business mailing address

915 N 77TH ST
SEATTLE WA
98103-4728
US

V. Phone/Fax

Practice location:
  • Phone: 206-232-8700
  • Fax:
Mailing address:
  • Phone: 917-682-8194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDI60231337
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: