Provider Demographics
NPI:1285331231
Name:CHAMBERLIN, RICHARD JAMES (MBA)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:JAMES
Last Name:CHAMBERLIN
Suffix:
Gender:M
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8465 W SAHARA AVE STE 111180
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-8960
Mailing Address - Country:US
Mailing Address - Phone:949-981-2852
Mailing Address - Fax:702-476-2302
Practice Address - Street 1:9027 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-3401
Practice Address - Country:US
Practice Address - Phone:949-981-2852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty