=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427143437
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SABRINA D. CHYZYK R.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 07/24/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4060 4TH AVE STE 508
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92103-2121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-260-7363
-----------------------------------------------------
Fax | 858-784-5933
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | FILE #54433
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90074-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-784-5767
-----------------------------------------------------
Fax | 858-784-5933
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 816509
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------