Provider Demographics
NPI:1104463124
Name:HUYNH, ZENAIDA (RD, LD)
Entity type:Individual
Prefix:
First Name:ZENAIDA
Middle Name:
Last Name:HUYNH
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6888 CRIMSON HORSE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5144
Mailing Address - Country:US
Mailing Address - Phone:702-499-3027
Mailing Address - Fax:702-479-6895
Practice Address - Street 1:5510 S FORT APACHE RD STE 114
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-7700
Practice Address - Country:US
Practice Address - Phone:702-908-8841
Practice Address - Fax:702-479-6895
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2024-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV39278-DI-0133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1104463124Medicaid