Provider Demographics
NPI:1699069781
Name:CHONG, NATASHA LEEANN (MPH, RD)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:LEEANN
Last Name:CHONG
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:LEANN
Other - Last Name:GABAN-CHONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPH, RD
Mailing Address - Street 1:25470 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-4900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25470 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 203
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-4900
Practice Address - Country:US
Practice Address - Phone:951-973-7290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01069524133V00000X
TXDT82041133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered