Provider Demographics
NPI:1629700208
Name:WEYDT, MAGDA A (MS, RD)
Entity Type:Individual
Prefix:
First Name:MAGDA
Middle Name:A
Last Name:WEYDT
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11946 MAPLE CREST ST
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-3170
Mailing Address - Country:US
Mailing Address - Phone:818-216-8853
Mailing Address - Fax:
Practice Address - Street 1:11946 MAPLE CREST ST
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-3170
Practice Address - Country:US
Practice Address - Phone:818-216-8853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA877295133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered