Provider Demographics
NPI:1528571569
Name:AHL, NANCY (RD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:AHL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:GAMBOA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:2212 E 4TH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3873
Mailing Address - Country:US
Mailing Address - Phone:714-628-3242
Mailing Address - Fax:
Practice Address - Street 1:2212 E 4TH ST STE 301
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3873
Practice Address - Country:US
Practice Address - Phone:714-628-3242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86038698133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered