Basic Information
| Provider Information | |||||||||
| NPI: | 1750814422 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LE | ||||||||
| FirstName: | THIA | ||||||||
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| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9015 HERSHEY ST | ||||||||
| Address2: | |||||||||
| City: | ROSEMEAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917702828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3235476398 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12401 WASHINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906021006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626980811 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2017 | ||||||||
| LastUpdateDate: | 04/09/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 891999 | CA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered | 133N00000X | 891999 | CA | N | Dietary & Nutritional Service Providers | Nutritionist | 133NN1002X | 891999 | CA | N | Dietary & Nutritional Service Providers | Nutritionist | Nutrition, Education |
No ID Information.