Individual
KHADEJA GHANIEZADEH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11201 BENTON ST, LOMA LINDA, CA 92357-1000
(909) 825-7084
Mailing address
11792 RANDOLPH CT, LOMA LINDA, CA 92354-4188
(909) 894-6905
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86074510
CA
Other
Enumeration date
09/07/2023
Last updated
03/14/2024
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