Provider Demographics
NPI:1326621533
Name:CHAN, DORA (PHARMD, NUTRITIONIST)
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:PHARMD, NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8781 PARADISE VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:LUCERNE
Mailing Address - State:CA
Mailing Address - Zip Code:95458-8549
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8781 PARADISE VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:LUCERNE
Practice Address - State:CA
Practice Address - Zip Code:95458-8549
Practice Address - Country:US
Practice Address - Phone:408-802-2068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist