MEDICARE: KITCHIE RAMOS MIANA R.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	933065	CA

General Provider Information

NPI Number	:	1528255320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KITCHIE RAMOS MIANA R.D.

Provider Business Mailing Address
First Line	:	26069 PAXTON PL
Second Line	:
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-6513
Country	:	US
Telephone Number	:	909-478-9540
Fax Number	:

Provider Business Practice Location Address
First Line	:	9161 SIERRA AVE
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92335-4729
Country	:	US
Telephone Number	:	909-427-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2007
Last Update Date	:	09/26/2007

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