Provider Demographics
NPI:1891480349
Name:QIU, JUANXIAO (RD, CNSC)
Entity Type:Individual
Prefix:
First Name:JUANXIAO
Middle Name:
Last Name:QIU
Suffix:
Gender:F
Credentials:RD, CNSC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:QIU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, CNSC
Mailing Address - Street 1:800 N DELAWARE ST APT 304
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-1510
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 N DELAWARE ST
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-1512
Practice Address - Country:US
Practice Address - Phone:617-304-2360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86081034133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered