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General NPI Number Information
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NPI Number | 1003692013
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Entity Type | Individual
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Provider Name | CANDRA AIYANA LAND REGISTERED DIETITIAN
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Gender | Female
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Dates
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Enumeration Date | 09/05/2023
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Last Update Date | 09/05/2023
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Provider Practice Location Address
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Address Line | 2400 S AVENUE A
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City | YUMA
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State | AZ
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Zip | 85364-7127
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Country | US
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Telephone | 928-336-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 10634 S EMERALD AVE
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City | YUMA
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State | AZ
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Zip | 85365-7120
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Country | US
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Telephone | 928-446-6958
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 86173213
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License Number State | AZ
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