Provider Demographics
NPI:1972174613
Name:GUAN, RHONDDA (RD)
Entity type:Individual
Prefix:
First Name:RHONDDA
Middle Name:
Last Name:GUAN
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:RHON
Other - Middle Name:
Other - Last Name:GUAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:430 EVERETT ST APT 1/2
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-3731
Mailing Address - Country:US
Mailing Address - Phone:818-835-6377
Mailing Address - Fax:
Practice Address - Street 1:747 52ND ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1809
Practice Address - Country:US
Practice Address - Phone:510-428-3209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-04
Last Update Date:2021-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86169176133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered