Provider Demographics
NPI:1093186173
Name:ABE, RAN (RD)
Entity Type:Individual
Prefix:
First Name:RAN
Middle Name:
Last Name:ABE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JOSEPHINE
Other - Middle Name:
Other - Last Name:SHUCART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1777 N BELLFLOWER BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-4020
Mailing Address - Country:US
Mailing Address - Phone:562-294-1441
Mailing Address - Fax:
Practice Address - Street 1:1777 N BELLFLOWER BLVD STE 205
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-4020
Practice Address - Country:US
Practice Address - Phone:562-294-1441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-14
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86032165133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA86032165OtherCOMMISSION ON DIETETIC REGISTRATION