Provider Demographics
NPI:1982198321
Name:LI, ZIQIAN (MS, RDN, CDCES, CNSC)
Entity Type:Individual
Prefix:
First Name:ZIQIAN
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:MS, RDN, CDCES, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1639 ALPINE FIR AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-2491
Mailing Address - Country:US
Mailing Address - Phone:216-262-2003
Mailing Address - Fax:
Practice Address - Street 1:1 ADVENTIST HEALTH WAY
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3266
Practice Address - Country:US
Practice Address - Phone:916-406-0177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86092086133V00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered