Provider Demographics
NPI:1760105621
Name:OCTAVIANO, KIA FELICIA BITANGCOL (RDN)
Entity Type:Individual
Prefix:
First Name:KIA FELICIA
Middle Name:BITANGCOL
Last Name:OCTAVIANO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8730 LA COLONIA AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3302
Mailing Address - Country:US
Mailing Address - Phone:562-253-8398
Mailing Address - Fax:
Practice Address - Street 1:8730 LA COLONIA AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3302
Practice Address - Country:US
Practice Address - Phone:562-253-8398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86087713133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education