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General NPI Number Information
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NPI Number | 1720914989
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Entity Type | Individual
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Provider Name | KELLY WOLSCHON RDN
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Gender | Female
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Dates
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Enumeration Date | 06/23/2026
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Last Update Date | 06/23/2026
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Provider Practice Location Address
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Address Line | 2211 VOORHEES AVE
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City | REDONDO BEACH
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State | CA
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Zip | 90278-2423
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Country | US
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Telephone | 310-947-9182
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Fax |
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Provider Business Mailing Address
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Address Line | 2211 VOORHEES AVE
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City | REDONDO BEACH
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State | CA
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Zip | 90278-2423
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Country | US
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Telephone |
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Fax | 310-947-9182
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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 | 133VN1005X
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Taxonomy Name | Renal Nutrition Registered Dietitian
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License Number | 805831
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License Number State | CA
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