Provider Demographics
NPI:1154969400
Name:HUYNH, MICHELLE NGUYEN (RD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:NGUYEN
Last Name:HUYNH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14252 MADERA CT
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-3780
Mailing Address - Country:US
Mailing Address - Phone:909-438-0585
Mailing Address - Fax:
Practice Address - Street 1:14252 MADERA CT
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-3780
Practice Address - Country:US
Practice Address - Phone:909-438-0585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered