Provider Demographics
NPI:1275273823
Name:HUYNH, MANDY T (RDN)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:T
Last Name:HUYNH
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 MILL VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1631
Mailing Address - Country:US
Mailing Address - Phone:619-886-1147
Mailing Address - Fax:
Practice Address - Street 1:1310 MILL VALLEY RD
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-1631
Practice Address - Country:US
Practice Address - Phone:619-886-1147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86155673133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered