Provider Demographics
NPI:1548556061
Name:MACHADO, HEATHER (RD, LDN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MACHADO
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-224 WEHENA PL
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-5052
Mailing Address - Country:US
Mailing Address - Phone:970-420-0650
Mailing Address - Fax:
Practice Address - Street 1:94-224 WEHENA PL
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-5052
Practice Address - Country:US
Practice Address - Phone:970-420-0650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX2987133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered