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NPI Code Detail

MEDICARE: MS. ANTONIA KNUDSEN RD

MEDICARE: MS. ANTONIA KNUDSEN RD
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
1133V00000XRegistered Dietitian634558CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ZZZ26959ZOTHERPPIN

General Provider Information

NPI Number : 1679658892
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ANTONIA KNUDSEN RD
Provider Business Mailing Address
First Line : 727 E FREMONT AVE
Second Line : FRESNO
City : FRESNO
State : CA
Zip : 93710-3940
Country : US
Telephone Number : 559-459-1672
Fax Number : 559-459-1058
Provider Business Practice Location Address
First Line : 1925 E DAKOTA AVE
Second Line :
City : FRESNO
State : CA
Zip : 93726-4821
Country : US
Telephone Number : 559-459-1672
Fax Number : 559-459-1058
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2006
Last Update Date : 07/08/2007

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Directions to “ MS. ANTONIA KNUDSEN RD” Practice Location

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