Provider Demographics
NPI:1528864246
Name:NAKAJIMA, HIROMI (DIETITIAN)
Entity type:Individual
Prefix:
First Name:HIROMI
Middle Name:
Last Name:NAKAJIMA
Suffix:
Gender:F
Credentials:DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 CAMBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-7512
Mailing Address - Country:US
Mailing Address - Phone:415-342-1920
Mailing Address - Fax:
Practice Address - Street 1:240 CAMBRIDGE LN
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-7512
Practice Address - Country:US
Practice Address - Phone:415-342-1920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-22
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86026843133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered