Provider Demographics
NPI:1710136288
Name:TSUKADA, STACIE NACHI
Entity Type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:NACHI
Last Name:TSUKADA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:STACIE
Other - Middle Name:NACHI
Other - Last Name:HOSOKAWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CNSD
Mailing Address - Street 1:5901 E 7TH ST
Mailing Address - Street 2:C/O NUTRITION & FOOD SERVICES
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90822-5201
Mailing Address - Country:US
Mailing Address - Phone:562-826-8000
Mailing Address - Fax:562-826-5947
Practice Address - Street 1:5901 E 7TH ST
Practice Address - Street 2:C/O NUTRITION & FOOD SERVICES
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90822-5201
Practice Address - Country:US
Practice Address - Phone:562-826-8000
Practice Address - Fax:562-826-5947
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
00928665OtherCOMMISSION ON DIETETIC REGISTRATION