Provider Demographics
NPI:1235884511
Name:HEDAYATTZADEH, LINA
Entity Type:Individual
Prefix:
First Name:LINA
Middle Name:
Last Name:HEDAYATTZADEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22185 GRAND ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:PALO CEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:96073-8805
Mailing Address - Country:US
Mailing Address - Phone:530-604-7248
Mailing Address - Fax:
Practice Address - Street 1:22185 GRAND ESTATES DR
Practice Address - Street 2:
Practice Address - City:PALO CEDRO
Practice Address - State:CA
Practice Address - Zip Code:96073-8805
Practice Address - Country:US
Practice Address - Phone:530-604-7248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty