Provider Demographics
NPI:1366098014
Name:SHIPIN, RAIZA (RD/RDN, LD)
Entity type:Individual
Prefix:
First Name:RAIZA
Middle Name:
Last Name:SHIPIN
Suffix:
Gender:F
Credentials:RD/RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 S GREEN VALLEY PKWY # 1018
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-0404
Mailing Address - Country:US
Mailing Address - Phone:323-578-4774
Mailing Address - Fax:
Practice Address - Street 1:2378 BROCKTON WAY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-5459
Practice Address - Country:US
Practice Address - Phone:323-578-4774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV35673-DI-2133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered