Provider Demographics
NPI:1407438914
Name:PAMBIANCO, CHELSEA CIERRA
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:CIERRA
Last Name:PAMBIANCO
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 1:128 W KNEPP AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-2328
Mailing Address - Country:US
Mailing Address - Phone:760-447-3194
Mailing Address - Fax:
Practice Address - Street 1:128 W KNEPP AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-2328
Practice Address - Country:US
Practice Address - Phone:760-447-3194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered