Provider Demographics
NPI:1699949503
Name:ENDRIZAL, CYNTHIA (PHD, RDN)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:ENDRIZAL
Suffix:
Gender:F
Credentials:PHD, RDN
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:KAHALEWALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:47-452 HUI IO ST
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-4613
Mailing Address - Country:US
Mailing Address - Phone:808-223-3957
Mailing Address - Fax:
Practice Address - Street 1:302 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-1841
Practice Address - Country:US
Practice Address - Phone:808-622-1618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI808558133VN1005X
133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIBG498ZMedicare UPIN
HIH103683Medicare UPIN