Individual
JOSEPHINE HADIWIDJOJO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RD, CDN
Contact information
Practice address
19936 MARIPOSA CREEK WAY, PORTER RANCH, CA 91326-4128
(818) 585-1163
Mailing address
19936 MARIPOSA CREEK WAY, PORTER RANCH, CA 91326-4128
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
832433
CA
Other
Enumeration date
02/01/2018
Last updated
02/01/2018
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